Provider Demographics
NPI:1023462603
Name:ANDERSON, CARRIE ROCHELLE (MSED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ROCHELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:401 WEST STREET
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-0027
Mailing Address - Country:US
Mailing Address - Phone:507-847-2423
Mailing Address - Fax:507-847-2422
Practice Address - Street 1:401 WEST ST
Practice Address - Street 2:SUITE 0115
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1219
Practice Address - Country:US
Practice Address - Phone:507-847-2423
Practice Address - Fax:507-847-2422
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01543101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional