Individual
DR. MARK RICHARD CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD LP
Contact information
Practice address
7200 FRANCE AVE, STE 327, EDINA, MN 55435-4310
(952) 835-2002
(952) 835-9889
Mailing address
7200 FRANCE AVE, STE 327, EDINA, MN 55435-4310
(952) 835-2002
(952) 835-9889
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4345
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125ROCA
BCBS
MN
01
—
6192920
MEDICA
MN
Enumeration date
10/16/2006
Last updated
07/08/2007
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