Provider Demographics
NPI:1275043341
Name:VALLEJOS, LISA (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:VALLEJOS
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 E GIRARD AVE STE B410
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5510
Mailing Address - Country:US
Mailing Address - Phone:415-636-1657
Mailing Address - Fax:
Practice Address - Street 1:10200 E GIRARD AVE STE B410
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5510
Practice Address - Country:US
Practice Address - Phone:415-636-1657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5160101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional