MEDICARE: KRISTIN LAVELLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	0011581	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548769805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTIN LAVELLE

Provider Business Mailing Address
First Line	:	PO BOX 1023
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-4023
Country	:	US
Telephone Number	:	303-514-1688
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 GARDEN CTR STE 128
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80020-2622
Country	:	US
Telephone Number	:	303-554-0357
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	KRISTIN LAVELLE
Credential	:	LPC
Telephone Number	:	303-554-0357

Provider Enumeration Date	:	02/01/2018
Last Update Date	:	02/01/2018

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Directions to “KRISTIN LAVELLE ” Practice Location

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