Provider Demographics
NPI:1942955067
Name:CARLSEN PSYCHIATRIC CARE LLC
Entity Type:Organization
Organization Name:CARLSEN PSYCHIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:CARLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:605-521-0921
Mailing Address - Street 1:3101 W 41ST ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-8130
Mailing Address - Country:US
Mailing Address - Phone:605-521-0921
Mailing Address - Fax:
Practice Address - Street 1:3101 W 41ST ST STE 209
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-8130
Practice Address - Country:US
Practice Address - Phone:605-521-0921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575930Medicaid