Provider Demographics
NPI:1275622623
Name:DECKER, LISA L (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:DECKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:10 BOULDER CRESCENT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3344
Mailing Address - Country:US
Mailing Address - Phone:719-651-7061
Mailing Address - Fax:719-632-6195
Practice Address - Street 1:10 BOULDER CRESCENT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3344
Practice Address - Country:US
Practice Address - Phone:719-651-7061
Practice Address - Fax:719-632-6195
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO150839OtherCOLORADO HEALTH NETWORK