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General NPI Number Information
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NPI Number | 1356859201
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Entity Type | Individual
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Provider Name | RYLEE ALYSANDER RAE LPCC
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Gender | Female
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 7203 PERRY CT E
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-1202
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Country | US
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Telephone | 929-888-7267
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Fax |
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Provider Business Mailing Address
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Address Line | 4014 GREEN HEIGHTS TRL SE
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City | PRIOR LAKE
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State | MN
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Zip | 55372-2450
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Country | US
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Telephone | 612-718-1970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CC03513
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License Number State | MN
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