Provider Demographics
NPI:1922651090
Name:KAUFMAN, CARISSA MEHITABEL (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:MEHITABEL
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 SHELARD PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6411
Mailing Address - Country:US
Mailing Address - Phone:612-547-8554
Mailing Address - Fax:763-432-6001
Practice Address - Street 1:9800 SHELARD PKWY STE 115
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6411
Practice Address - Country:US
Practice Address - Phone:612-547-8554
Practice Address - Fax:763-432-6001
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3236106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist