Provider Demographics
NPI:1386169704
Name:CARLISLE, LAURA (LADC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:LERITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:7700 HUDSON RD STE 600
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1469
Mailing Address - Country:US
Mailing Address - Phone:651-252-6032
Mailing Address - Fax:
Practice Address - Street 1:7700 HUDSON RD STE 600
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1469
Practice Address - Country:US
Practice Address - Phone:651-252-6032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor