Brooke Carlson
Individual provider Active NPI Professional Counselor · Wayzata, MN
NPI 1366096356 · NPPES record last updated Sep 7, 2023
Key facts
- NPI
- 1366096356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- CC02979 (MN)
- Practice address
- 600 Twelve Oaks Center Dr Ste 662
Wayzata, MN 55391-4525 - Phone
- (585) 478-0268
- NPI assigned
- Jul 28, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CC02979 | MN | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wholehearted Healing LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MN | ||
| Professional Counselor | 101YP2500X | CC02979 | MN | Yes |
Addresses
Primary practice location
600 Twelve Oaks Center Dr Ste 662
Wayzata, MN 55391-4525
Mailing address
13784 Candice LN
Eden Prairie, MN 55346-3059
Phone (585) 478-0268
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 390200000X | Medicaid | MN |
Other providers in Wayzata, MN
- Camara Good LLC
- Abigail Campbell
- Lori R Cao
- Carelink, Inc.
- Caretap Ut
- Jolene Margaret Carlson
- Tara Carlson
- Katherine Ann Carosella
- Christa Marie Carpenter
- Julia May Carpenter
All providers in Wayzata, MN · Professional Counselor in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.