1609956283 NPI number — Carlsen Psychiatric Care, LLC Dr. Jeanne Carol Carlsen DNP, MSN, BS, RN, LMFT, CNS, CNP, PMHCNS-BC, PMHNP-BC

Table of content: Dr. Jeanne Carol Carlsen DNP, MSN, BS, RN, LMFT, CNS, CNP, PMHCNS-BC, PMHNP-BC (NPI 1609956283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609956283 NPI number — Carlsen Psychiatric Care, LLC Dr. Jeanne Carol Carlsen DNP, MSN, BS, RN, LMFT, CNS, CNP, PMHCNS-BC, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Carlsen Psychiatric Care, LLC
Provider Last Name:
Carlsen
Provider First Name:
Jeanne
Provider Middle Name:
Carol
Provider Name Prefix Text:
Dr.
Provider Name Suffix Text:
Provider Credential Text:
DNP, MSN, BS, RN, LMFT, CNS, CNP, PMHCNS-BC, PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609956283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2210 S BROWN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57105-6582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-336-1974
Provider Business Mailing Address Fax Number:
605-336-9031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 S BROWN PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105-6582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-336-1974
Provider Business Practice Location Address Fax Number:
605-336-9031
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  SD-CNP CP001455 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0808X , with the licence number: SD-CNS CS004018 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0807X , with the licence number: LMFT1110 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: SD-RN R011625 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6575930 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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