Provider Demographics
NPI:1780093500
Name:ORTLIEB, LALAINE ARBUTHNOT (MA, BCC, LADC)
Entity type:Individual
Prefix:MS
First Name:LALAINE
Middle Name:ARBUTHNOT
Last Name:ORTLIEB
Suffix:
Gender:F
Credentials:MA, BCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 WAYZATA BLVD, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305
Mailing Address - Country:US
Mailing Address - Phone:612-454-2412
Mailing Address - Fax:952-546-1683
Practice Address - Street 1:11900 WAYZATA BLVD, SUITE 100
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305
Practice Address - Country:US
Practice Address - Phone:612-454-2412
Practice Address - Fax:952-546-1683
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303523101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)