Healthcare Provider Details

I. General information

NPI: 1871868471
Provider Name (Legal Business Name): JOSE M. LAFOSSE, PH.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9745 E HAMPDEN AVE SUITE 200
DENVER CO
80231-4920
US

IV. Provider business mailing address

9745 E HAMPDEN AVE SUITE 200
DENVER CO
80231-4920
US

V. Phone/Fax

Practice location:
  • Phone: 303-964-5261
  • Fax: 303-926-1764
Mailing address:
  • Phone: 303-964-5261
  • Fax: 303-926-1764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE MARCOS LAFOSSE
Title or Position: OWNER/CLINICAL NEUROPSYCHOLOGIST
Credential: PH.D.
Phone: 303-964-5261