Provider Demographics
NPI:1770794828
Name:LALLY, CATHERINE THERESE (PHD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:THERESE
Last Name:LALLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:821 RAYMOND AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1503
Mailing Address - Country:US
Mailing Address - Phone:651-271-1713
Mailing Address - Fax:651-645-0660
Practice Address - Street 1:821 RAYMOND AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1503
Practice Address - Country:US
Practice Address - Phone:651-271-1713
Practice Address - Fax:651-645-0660
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3350103TC1900X
MNLMFT915106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist