1801302146 NPI number — ANNA LACASSE RBT

Table of content: ANNA LACASSE RBT (NPI 1801302146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801302146 NPI number — ANNA LACASSE RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LACASSE
Provider First Name:
ANNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801302146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18521 E QUEEN CREEK RD STE 105-627
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEEN CREEK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85142-5870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-361-1025
Provider Business Mailing Address Fax Number:
480-814-7488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 N LAST CHANCE GULCH STE 403
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601-5028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-361-1025
Provider Business Practice Location Address Fax Number:
480-814-7488
Provider Enumeration Date:
12/22/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-21-51853 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1-21-51853 . This is a "BCBA" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".