Healthcare Provider Details

I. General information

NPI: 1245206291
Provider Name (Legal Business Name): DEBRA S LALLEY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 6TH AVE N ST CLOUD HOSPITAL BEHAVIORAL HEALTH CLINIC
ST CLOUD MN
56303
US

IV. Provider business mailing address

1406 6TH AVE N ST CLOUD HOSPITAL BEHAVIORAL HEALTH CLINIC
ST CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4908
  • Fax: 320-656-7026
Mailing address:
  • Phone: 320-229-4908
  • Fax: 320-656-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0820028
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0148074
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberR0820028
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: