Individual
DR. CAROLE (NICKEY) GALUSH LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD LP LMFT LADC
Contact information
Practice address
7400 METRO BLVD, SUITE 215, EDINA, MN 55439-2316
(952) 929-8432
(952) 929-8432
Mailing address
7400 METRO BLVD, SUITE 215, EDINA, MN 55439-2316
(952) 929-8432
(952) 929-8432
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
300756
MN
103T00000X
Psychologist
Primary
1810
MN
106H00000X
Marriage & Family Therapist
466
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122275
HEALTH PARTNERS FINANCIAL
—
01
—
46714LA
BCBS GROUP
—
01
—
46715LA
BCBS INDIVIDUAL
—
05
—
563350800
—
MN
Enumeration date
02/15/2007
Last updated
11/02/2015
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