Individual
DR. CHARLES LAVALLE PAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1404
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07014046
—
CO
05
—
113597000
—
WY
Enumeration date
09/23/2006
Last updated
10/27/2016
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