Healthcare Provider Details

I. General information

NPI: 1316097736
Provider Name (Legal Business Name): DAVID JOSEPH LACOURT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 CARLISLE BLVD NE SUITE F
ALBUQUERQUE NM
87107-4565
US

IV. Provider business mailing address

1175 GREEN ACRES LN
BOSQUE FARMS NM
87068-9017
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-1629
  • Fax: 505-869-1640
Mailing address:
  • Phone: 505-869-1801
  • Fax: 505-869-1640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number525
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301002442
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240926
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: