Provider Demographics
NPI:1437809746
Name:LAVIOLA PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:LAVIOLA PSYCHOLOGICAL SERVICES
Other - Org Name:PRISM PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:714-614-5169
Mailing Address - Street 1:1400 E SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4044
Mailing Address - Country:US
Mailing Address - Phone:208-966-4206
Mailing Address - Fax:
Practice Address - Street 1:1400 E SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4044
Practice Address - Country:US
Practice Address - Phone:208-966-4206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty