Individual
DR. CHARLES LAVALLE PAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
149 W HARVARD ST, SUITE 202, FORT COLLINS, CO 80525-2186
(970) 682-1173
(970) 282-1782
Mailing address
149 W HARVARD ST, SUITE 202, FORT COLLINS, CO 80525-2186
(970) 682-1173
(970) 282-1782
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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