LISA WALLACE (NPI# 1336779925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1336779925 |
Entity Type | Individual |
Full Name | LISA WALLACE |
Credential | LPC |
Practice Address |
2769 Iris Ave Ste 107 Boulder CO 80304-4405 |
Mailing Address |
1600 Bradley Ct Boulder CO 80305-7310 |
Practice Telephone | 9703689185 |
Mailing Telephone | 9703893612 |
Enumeration Date | 2020-01-22 |
Last Update Date | 2020-01-22 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 101YP2500X |
Counselor Specialization: Professional |
0015978 | CO | Behavioral Health & Social Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CO | CAQH | 14607457 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1396368064 | Lisa Jean Wallace | Occupational Therapy Assistant | 480 Somerset St Unit 1, North Plainfield, NJ 07060-4018 | 2020-05-28 |
1710521968 | Lisa Anne Wallace | Counselor | 418 Barr Rd, Lexington, SC 29072-2363 | 2019-10-31 |
1598225930 | Lisa Buckner Wallace | Counselor | 3750 N Center St, Hickory, NC 28601-8089 | 2019-03-21 |
1235637182 | Lisa M. Wallace | Nurse Practitioner | 800 E Cheves St Ste 200, Florence, SC 29506-2651 | 2018-01-25 |
1134575475 | Lisa Wallace | Counselor | 14 Farmer Rd, Milton, MA 02186-3743 | 2016-05-05 |
1720476641 | Lisa Wallace | Registered Nurse | 7601 Hospital Dr Ste 202, Sacramento, CA 95823-5408 | 2014-12-30 |
1134438286 | Lisa M Wallace | Nurse Practitioner | 831 N Theatre Drive, Marion, IN 46952-1701 | 2010-10-06 |
1124002571 | Lisa M Wallace | Counselor | 1807 Capitol Ave, Suite 101 A, Cheyenne, WY 82001-4544 | 2005-11-30 |
1003423658 | Lisa Carol Wallace | Nurse Practitioner | 2418 180th St, Allerton, IA 50008-8715 | 2020-09-28 |
1992368872 | Lisa Wallace | Licensed Practical Nurse | 27777 Inkster Rd, Farmington Hills, MI 48334-5326 | 2019-04-17 |
Street Address |
2769 IRIS AVE STE 107 |
City | BOULDER |
State | CO |
Zip Code | 80304-4405 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720605256 | Evol.v Chiropractic LLC | Chiropractor | 2401 Broadway #208, Boulder, CO 80304 | 2020-07-01 |
1760038723 | Patrica Anne Zeyher | Counselor | 100 Alpine Ave., Boulder, CO 80304 | 2019-08-15 |
1356855928 | Opal Counseling Center, LLC | Counselor | 1480 Lee Hill Dr. #7, Boulder, CO 80304 | 2017-11-19 |
1831608603 | Lesley Ann Cloke | Dietitian, Registered | 1895 Bluff St., Unit C, Boulder, CO 80304 | 2017-09-25 |
1790209740 | Megan Litwiller | Occupational Therapist | 810 Maxwell Ave, Boulder, CO 80304 | 2017-08-01 |
1285163774 | Nadine Martin | Registered Nurse | 311 Mapleton Ave # 331, Boulder, CO 80304 | 2017-06-08 |
1598119281 | Megan Cronin Larson | Social Worker | 825 S. Broadway Street, Boulder, CO 80304 | 2016-04-19 |
1760844237 | Rafia Rebeck | Counselor | 1235 Elder Ave #7, Boulder, CO 80304 | 2016-03-24 |
1629441688 | Jennifer S Delaney | Counselor | 2334 Broadway, Ste. B, Boulder, CO 80304 | 2015-11-12 |
1891162301 | Kingston Dialysis LLC | Clinic/Center | 2880 Folsom St Ste 110, Boulder, CO 80304 | 2015-09-01 |
Find all providers in zip 80304 |
Taxonomy Code | 101YP2500X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Counselor |
Specialization | Professional |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1881205466 | Sara Horn | Counselor | 4650 White Rock Cir Apt 12, Boulder, CO 80301-5373 | 2020-08-16 |
1669095618 | Allison Margaret Leddy Villarreal | Counselor | 737 29th St Ste 200f, Boulder, CO 80303-2474 | 2020-05-26 |
1265053961 | Positive Regard Psychotherapy Pllc | Counselor | 3102 Gamow Ln, Boulder, CO 80301-5465 | 2020-05-04 |
1154953776 | Willow Mae Arlenea | Counselor | 4500 19th St Lot 379, Boulder, CO 80304-0663 | 2020-02-11 |
1952952764 | Lauren Bleu Northrup | Counselor | 170 Seminole Dr, Boulder, CO 80303-4227 | 2019-09-23 |
1750947289 | Shelly Froehlich | Counselor | 1637 28th St Ste 201, Boulder, CO 80301-1001 | 2019-05-09 |
1003470139 | Kim Ann Merrill | Counselor | 6658 Gunpark Dr Ste 201, Boulder, CO 80301-3375 | 2019-04-24 |
1477019222 | Elizabeth Ann Maher | Counselor | 4949 Broadway St Ste 201, Boulder, CO 80304-0578 | 2019-02-18 |
1124592225 | Stepheny Antrobus | Counselor | 100 Arapahoe Lane, Suite 12, Boulder, CO 80302 | 2019-01-11 |
1679042766 | Julie Lynn Holburn | Counselor | 737 29th St Ste 200-g, Boulder, CO 80303-2317 | 2018-11-18 |
Find all providers in BOULDER |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.