Provider Demographics
NPI:1548857907
Name:LACASSE, ANITA RANI (LAC)
Entity type:Individual
Prefix:MISS
First Name:ANITA
Middle Name:RANI
Last Name:LACASSE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-2743
Mailing Address - Country:US
Mailing Address - Phone:406-217-6007
Mailing Address - Fax:855-873-1194
Practice Address - Street 1:914 20TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2743
Practice Address - Country:US
Practice Address - Phone:406-217-6007
Practice Address - Fax:855-873-1194
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBHH-LAC-LIC-38375101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)