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Lisa Wallace, LPC
Professional Counselor in Boulder, Colorado
NPI 1336779925

Lisa Wallace is a Professional Counselor based in Boulder, CO and is specialized in Professional. Lisa Wallace practices in Boulder, CO and has the professional credentials of LPC. The NPI Number for Lisa Wallace is 1336779925 and holds a License No. 0015978 (Colorado).

The current practice location address for Lisa Wallace is 2769 Iris Ave Ste 107, Boulder, CO and can be reached out via phone at 970-368-9185.

Location: 2769 Iris Ave Ste 107, Boulder, CO, 80305-7310
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1336779925
Provider Name
Lisa Wallace
Credential
LPC
Provider Entity Type
Individual
Gender
Female
Address
2769 Iris Ave Ste 107, Boulder, CO, 80305-7310
Phone Number
970-368-9185
Fax Number
Provider Enumeration Date
01/22/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
14607457 01 CO CAQH
institution
Provider Business Practice Location Address Details
Address
2769 Iris Ave Ste 107
City
Boulder
State
Colorado
Zip
80304-4405
Phone Number
970-368-9185
Fax Number
person
Provider Business Mailing Address Details
Address
2769 Iris Ave Ste 107
City
Boulder
State
Colorado
Zip
80304-4405
Phone Number
970-368-9185
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
101YP2500X
License No.
0015978 (Colorado)
Definition
Definition to come...
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