Provider Demographics
NPI:1366748576
Name:DEHNBOSTEL, CAROLYN (LMFT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:DEHNBOSTEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:GOODELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1601 WOODBINE LN
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1062
Mailing Address - Country:US
Mailing Address - Phone:612-242-9455
Mailing Address - Fax:
Practice Address - Street 1:1611 COUNTY ROAD B, SUITE 303
Practice Address - Street 2:MN COUPLE THERAPY CENTER
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-340-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1777106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist