Individual
HALEY CARLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, PMHNP-BC
Contact information
Practice address
1155 FORD RD, SUITE B, ST LOUIS PARK, MN 55426-1099
(952) 378-1800
(952) 378-1714
Mailing address
3100 W LAKE ST, SUITE 210, MINNEAPOLIS, MN 55416-4527
(612) 925-6033
(612) 925-8496
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R 197063-4
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CNP 4630
MN
Other
Enumeration date
05/19/2016
Last updated
04/26/2017
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