Provider Demographics
NPI:1790791705
Name:LAFORGE, WILLIAM (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:LAFORGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28362 VINCENT MORAGA DR
Mailing Address - Street 2:STE C
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3655
Mailing Address - Country:US
Mailing Address - Phone:951-699-9055
Mailing Address - Fax:951-699-8586
Practice Address - Street 1:28362 VINCENT MORAGA DR
Practice Address - Street 2:STE C
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3655
Practice Address - Country:US
Practice Address - Phone:951-699-9055
Practice Address - Fax:951-699-8586
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT9355106H00000X
CAPSY8015103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA134791OtherVALUEOPTIONS
CA71959OtherMANAGED HEALTH NETWORK
CA134791OtherVALUEOPTIONS