Provider Demographics
NPI:1891081246
Name:LAFAVE, GERARD LAWRENCE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:LAWRENCE
Last Name:LAFAVE
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58826 OTTER DR
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55037-5355
Mailing Address - Country:US
Mailing Address - Phone:612-240-7647
Mailing Address - Fax:320-384-6799
Practice Address - Street 1:58826 OTTER DR
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:MN
Practice Address - Zip Code:55037-5355
Practice Address - Country:US
Practice Address - Phone:612-240-7647
Practice Address - Fax:320-384-6799
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist