1063425122 NPI number — ABIGAIL W LAVOO PHD LPC LAC

Table of content: (NPI 1114817202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063425122 NPI number — ABIGAIL W LAVOO PHD LPC LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAVOO
Provider First Name:
ABIGAIL
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD LPC LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WITHERS LAVOO
Provider Other First Name:
ABIGAIL
Provider Other Middle Name:
WITHER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, LAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063425122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6660 DELMONICO DR D210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-298-3343
Provider Business Mailing Address Fax Number:
303-532-5079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7660 GODDARD ST STE 234
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80920-8231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-298-3343
Provider Business Practice Location Address Fax Number:
303-532-5079
Provider Enumeration Date:
08/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  3980LPC , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 232LAC , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 6360 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: LAC , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LAC232 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP1600X , with the licence number: 3980 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 3980 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 3980-LPC , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: LPC , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28632508 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".