Wallace, Lisa M

Wallace, Lisa M is an individual health care provider with primary practice located at 4103 E Boardwalk Drive Suite 202, Fort Collins CO 80525-5930. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Wallace, Lisa M can be contacted via phone (970) 817-4049.

Contact Information

Primary practice address
4103 E Boardwalk Drive Suite 202 Fort Collins CO 80525-5930
Phone: (970) 817-4049
Fax: (877) 833-4460
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 906 Wyoming
Behavioral Health & Social Service Providers / Professional 101YP2500X 5913 Colorado

Profile Details

NPI number 1124002571
LBN Legal business name Wallace, Lisa M
Credentials MA, LPC
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 30th, 2005
Last updated Mar 15th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124002571 NPPES
Wyoming Other 312410 BS OF WY

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