Provider Demographics
NPI:1427503481
Name:ESCHILETTI PRATI, LAISSA (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:LAISSA
Middle Name:
Last Name:ESCHILETTI PRATI
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:LAISSA
Other - Middle Name:
Other - Last Name:LEOPARDO ESCHILETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6519 TOMBSTONE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-6501
Mailing Address - Country:US
Mailing Address - Phone:970-889-4862
Mailing Address - Fax:
Practice Address - Street 1:300 BOARDWALK DR
Practice Address - Street 2:UNIT 5-A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3070
Practice Address - Country:US
Practice Address - Phone:970-223-2256
Practice Address - Fax:970-223-2324
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004455103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist