Healthcare Provider Details

I. General information

NPI: 1013247097
Provider Name (Legal Business Name): CHRISTOPHER D LAVIOLA PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
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 TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-203139
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-203139
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number972
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: