Organization
NOVA BHS
Active
Other names
Maryanne Lassegard
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY ANNE LASSEGARD PH.D. (OWNER)
(612) 306-4721
Entity
Organization
Contact information
Practice address
521 TANGLEWOOD DR., SHOREVIEW, MN 55126
(612) 306-4721
(763) 434-6570
Mailing address
3340 INTERLACHEN DR., HAM LAKE, MN 55304
(612) 306-4721
(763) 434-6570
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
LP2187
MN
103TC0700X
Clinical Psychologist
LP2187
MN
103TH0100X
Health Service Psychologist
LP2187
MN
103TP2701X
Group Psychotherapy Psychologist
LP2187
MN
208VP0014X
Interventional Pain Medicine Physician
Primary
LP2187
MN
Other
Enumeration date
04/02/2015
Last updated
04/02/2015
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