Provider Demographics
NPI:1578617759
Name:CARLSON, DANIEL R (MDIV MSW LICSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:R
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MDIV MSW LICSW
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Mailing Address - Street 1:1300 GODWARD ST NE
Mailing Address - Street 2:SUITE 6900
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-3002
Mailing Address - Country:US
Mailing Address - Phone:612-339-3367
Mailing Address - Fax:612-333-9969
Practice Address - Street 1:1300 GODWARD ST NE
Practice Address - Street 2:SUITE 6900
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-3002
Practice Address - Country:US
Practice Address - Phone:612-339-3367
Practice Address - Fax:612-333-9969
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2015-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN113911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN54168OtherHEALTH PARTNERS
MN7G652CAOtherBLUE CROSS
MN259317300Medicaid
MN800000788Medicare UPIN