Provider Demographics
NPI:1336195874
Name:CAROLE, LINDA FLIES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:FLIES
Last Name:CAROLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14422 HUNTERS LN
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2282
Mailing Address - Country:US
Mailing Address - Phone:952-226-6934
Mailing Address - Fax:
Practice Address - Street 1:4005 W 65TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1720
Practice Address - Country:US
Practice Address - Phone:612-251-4179
Practice Address - Fax:952-224-7990
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2828103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN209K7CAOtherBLUE CROSS BLUE SHIELD
MN61-63979OtherUNITED HEALTHCARE
MN768048100OtherMINNESOTA HEALTH CARE PROGRAMS
MN209K7CAOtherBLUE CROSS BLUE SHIELD