Provider Demographics
NPI:1295398139
Name:LEWALLEN, CHRISTINE MARGARET ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARGARET ELIZABETH
Last Name:LEWALLEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MARGARET
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4851 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6715
Mailing Address - Country:US
Mailing Address - Phone:303-432-5312
Mailing Address - Fax:
Practice Address - Street 1:31207 KEATS WAY STE 202
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2220
Practice Address - Country:US
Practice Address - Phone:303-425-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional