Provider Demographics
NPI:1134422595
Name:MCKEAN, CARLA MARIE (MA LMFT, LADC)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:MCKEAN
Suffix:
Gender:F
Credentials:MA LMFT, LADC
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:MARIE
Other - Last Name:MARTINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LMFT, LADC
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-0974
Mailing Address - Country:US
Mailing Address - Phone:651-755-4276
Mailing Address - Fax:888-972-5307
Practice Address - Street 1:12814 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9345
Practice Address - Country:US
Practice Address - Phone:651-755-4276
Practice Address - Fax:888-972-5307
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302991101YA0400X
MN2626106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1174955397Medicaid
MN1134422595Medicaid