Provider Demographics
NPI:1669490066
Name:PARSONS, CAROLYN DOROTHY (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:DOROTHY
Last Name:PARSONS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7040 LAKELAND AVE NORTH
Mailing Address - Street 2:#208 PARSONS PSYCHOLOGICAL SERVICES, LLC
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428
Mailing Address - Country:US
Mailing Address - Phone:763-566-1174
Mailing Address - Fax:763-503-4692
Practice Address - Street 1:7040 LAKELAND AVE NORTH
Practice Address - Street 2:#208 PARSONS PSYCHOLOGICAL SERVICES, LLC
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428
Practice Address - Country:US
Practice Address - Phone:763-566-1174
Practice Address - Fax:763-503-4692
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3198103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN854219800Medicaid