Individual
DR. MARK CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D., LP
Contact information
Practice address
7066 STILLWATER BLVD N, OAKDALE, MN 55128-3937
(651) 777-5222
(651) 251-5111
Mailing address
7066 STILLWATER BLVD N, OAKDALE, MN 55128-3937
(651) 777-5222
(651) 251-5111
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2212
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G040CA
BCBS
MN
01
—
106227
UC
MN
01
—
17577
HP
MN
01
—
242966
CP
MN
01
—
570003
P1
MN
01
—
61-20016
UBH
MN
Enumeration date
07/26/2006
Last updated
07/08/2007
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