Provider Demographics
NPI:1750680054
Name:CARLSON, JULIANNE L (LPCC)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:L
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16694 70TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56357-8533
Mailing Address - Country:US
Mailing Address - Phone:763-464-2984
Mailing Address - Fax:
Practice Address - Street 1:200 3RD AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1298
Practice Address - Country:US
Practice Address - Phone:320-629-7600
Practice Address - Fax:651-925-0071
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00388101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional