Mark Richard Carlson, PSYD LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP4345 Issued in MN

Practice address

7200 France Ave
Ste 327
Edina, MN 55435-4310

Phone

(952) 835-2002

Fax

(952) 835-9889

NPI assigned

Oct 16, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mental Health Systems PC

  • Psychologist
  • Edina, MN
  • NPI 1497835656
  Authorized official Same address or phone
• Youable Emotional Health Services

  • Community/Behavioral Health Agency
  • Richfield, MN
  • NPI 1386728228
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891875050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7200 FRANCE AVE",
            "address_2": "STE 327",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354310",
            "telephone_number": "952-835-2002",
            "fax_number": "952-835-9889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 FRANCE AVE",
            "address_2": "STE 327",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354310",
            "telephone_number": "952-835-2002",
            "fax_number": "952-835-9889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "MARK",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "PSYD LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP4345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "125ROCA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6192920",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carol M Carlson, MD
• Daniel Aaron Carlson, M.D.
• Daren Eugene Carlson, MA, LMFT
• Gary J. Carlson, MD
• Mackenzie Lee Carlson, PA
• Samuel W Carlson, MD
• Sara Carolyn Carlson, M.A. LMFT
• Alana Marie Carnevale
• Patrick Carney, M.D.
• Alison Caro, ATC

• Psychologist in Edina, MN
• Providers in Edina, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.