Provider Demographics
NPI:1023507753
Name:CARLA HAMAND LLC
Entity type:Organization
Organization Name:CARLA HAMAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HAMAND
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-216-5151
Mailing Address - Street 1:301 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-1139
Mailing Address - Country:US
Mailing Address - Phone:507-216-5151
Mailing Address - Fax:507-634-7120
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KASSON
Practice Address - State:MN
Practice Address - Zip Code:55944-1139
Practice Address - Country:US
Practice Address - Phone:507-216-5151
Practice Address - Fax:507-634-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN142111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1083907935Medicaid