Provider Demographics
NPI:1215900147
Name:LA CERTE, LANCE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:
Last Name:LA CERTE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 S XANADU WAY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-6544
Mailing Address - Country:US
Mailing Address - Phone:303-369-9024
Mailing Address - Fax:303-369-9024
Practice Address - Street 1:2280 S XANADU WAY
Practice Address - Street 2:SUITE 305
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6544
Practice Address - Country:US
Practice Address - Phone:303-369-9024
Practice Address - Fax:303-369-9024
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80306Medicare ID - Type Unspecified