Provider Demographics
NPI:1750700027
Name:CARRISON, AMY (LP, LADC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:CARRISON
Suffix:
Gender:F
Credentials:LP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1288
Mailing Address - Country:US
Mailing Address - Phone:612-223-8898
Mailing Address - Fax:
Practice Address - Street 1:1155 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1288
Practice Address - Country:US
Practice Address - Phone:612-223-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103T00000X
MN6587103T00000X
MN301529101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)