Provider Demographics
NPI:1720340102
Name:LASALLE, MORGAN RAE (LMFT, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:RAE
Last Name:LASALLE
Suffix:
Gender:F
Credentials:LMFT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30605 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-2162
Mailing Address - Country:US
Mailing Address - Phone:320-733-0411
Mailing Address - Fax:
Practice Address - Street 1:160 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353
Practice Address - Country:US
Practice Address - Phone:320-983-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-12579103K00000X
CA82223106H00000X
MN3372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst