Provider Demographics
NPI:1306285549
Name:SANDERS, LAVINA LEANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAVINA
Middle Name:LEANNE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAVINA
Other - Middle Name:LEANNE
Other - Last Name:CAVASOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2619 BAR HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2607
Mailing Address - Country:US
Mailing Address - Phone:505-328-0853
Mailing Address - Fax:
Practice Address - Street 1:500 FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-4210
Practice Address - Country:US
Practice Address - Phone:720-591-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004785103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth