Provider Demographics
NPI:1336466812
Name:LASHBROOKE, VIRGINIA LEE (MFT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE
Last Name:LASHBROOKE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 COUNTY ROAD 224
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7033
Mailing Address - Country:US
Mailing Address - Phone:970-382-0109
Mailing Address - Fax:
Practice Address - Street 1:2243 MAIN AVE
Practice Address - Street 2:STE 4
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4699
Practice Address - Country:US
Practice Address - Phone:970-382-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO191106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO191OtherLICENSE