Provider Demographics
NPI:1245504091
Name:ANAM CARA THERAPIES, PLLC
Entity type:Organization
Organization Name:ANAM CARA THERAPIES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR AND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MSW, LICSW
Authorized Official - Phone:612-462-3812
Mailing Address - Street 1:3646 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2712
Mailing Address - Country:US
Mailing Address - Phone:612-462-3812
Mailing Address - Fax:612-573-6682
Practice Address - Street 1:3646 14TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2712
Practice Address - Country:US
Practice Address - Phone:612-462-3812
Practice Address - Fax:612-573-6682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-25
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8909251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1679602460Medicare UPIN