Healthcare Provider Details

I. General information

NPI: 1437809746
Provider Name (Legal Business Name): LAVIOLA PSYCHOLOGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E SHERMAN AVE
COEUR D ALENE ID
83814-4044
US

IV. Provider business mailing address

1400 E SHERMAN AVE
COEUR D ALENE ID
83814-4044
US

V. Phone/Fax

Practice location:
  • Phone: 208-966-4206
  • Fax:
Mailing address:
  • Phone: 208-966-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER D LAVIOLA
Title or Position: PRESIDENT
Credential: PSYD
Phone: 208-966-4206