1689124315 NPI number — LAISSA PRATI PSYCHOLOGY PRIVATE PRACTICE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689124315 NPI number — LAISSA PRATI PSYCHOLOGY PRIVATE PRACTICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAISSA PRATI PSYCHOLOGY PRIVATE PRACTICE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689124315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6519 TOMBSTONE RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIMNATH
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80547-6501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-889-4862
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 BOARDWALK DR
Provider Second Line Business Practice Location Address:
UNIT 5-A
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80525-3070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-223-2256
Provider Business Practice Location Address Fax Number:
970-223-2324
Provider Enumeration Date:
10/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ESCHILETTI PRATI
Authorized Official First Name:
LAISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
970-889-4862

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  PSY.0004455 , 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)





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