Provider Demographics
NPI:1356859201
Name:RAE, RYLEE ALYSANDER (LPCC)
Entity Type:Individual
Prefix:
First Name:RYLEE
Middle Name:ALYSANDER
Last Name:RAE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 GREEN HEIGHTS TRL SE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2450
Mailing Address - Country:US
Mailing Address - Phone:612-718-1970
Mailing Address - Fax:
Practice Address - Street 1:7203 PERRY CT E
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1202
Practice Address - Country:US
Practice Address - Phone:929-888-7267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MNCC03513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program