person
Lisa M Wallace, MA,LPC
Professional Counselor in Fort Collins, Colorado
NPI 1124002571

Lisa M Wallace is a Professional Counselor based in Fort Collins, CO and is specialized in Professional. Lisa M Wallace practices in Fort Collins, CO and has the professional credentials of MA,LPC. The NPI Number for Lisa M Wallace is 1124002571 and holds a License No. 906 (Colorado).

The current practice location address for Lisa M Wallace is 4103 E Boardwalk Drive, Fort Collins, CO and can be reached out via phone at 970-817-4049 and via fax at 877-833-4460.

Location: 4103 E Boardwalk Drive, Fort Collins, CO, 80527-3338
person
Provider Profile Details
NPI Number
1124002571
Provider Name
Lisa M Wallace
Credential
MA,LPC
Provider Entity Type
Individual
Gender
Female
Address
4103 E Boardwalk Drive, Fort Collins, CO, 80527-3338
Phone Number
970-817-4049
Fax Number
877-833-4460
Provider Enumeration Date
11/30/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
312410 01 WY BS OF WY
institution
Provider Business Practice Location Address Details
Address
4103 E Boardwalk Drive
City
State
Zip
80525-5930
Phone Number
970-817-4049
Fax Number
877-833-4460
person
Provider Business Mailing Address Details
Address
4103 E Boardwalk Drive
City
State
Zip
80525-5930
Phone Number
970-817-4049
Fax Number
877-833-4460
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
5913 (Colorado)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
906 (Wyoming)
Definition
Definition to come...
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