Provider Demographics
NPI:1760753735
Name:LANCE LA CERTE, PSY.D.,P.C.
Entity Type:Organization
Organization Name:LANCE LA CERTE, PSY.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LA CERTE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:303-369-9024
Mailing Address - Street 1:2260 S XANADU WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1373
Mailing Address - Country:US
Mailing Address - Phone:303-369-9024
Mailing Address - Fax:303-369-9024
Practice Address - Street 1:2260 S XANADU WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1373
Practice Address - Country:US
Practice Address - Phone:303-369-9024
Practice Address - Fax:303-369-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80306Medicare UPIN