Provider Demographics
NPI:1780901579
Name:RASMUSSEN, LAURIE JO (CMHC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:JO
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:JO
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5564 S 3150 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9716
Mailing Address - Country:US
Mailing Address - Phone:435-720-2174
Mailing Address - Fax:
Practice Address - Street 1:5564 S 3150 W
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-9716
Practice Address - Country:US
Practice Address - Phone:435-720-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-18650101YM0800X
MTBBH-LCPC-55807101YM0800X
UT10160739-6004101YM0800X
IDLCPC-6862101YM0800X
WYLPC-1717101YM0800X
NVCP1122-R101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health