Provider Demographics
NPI:1407125818
Name:LISA D. STINSON, PH.D., LLC
Entity Type:Organization
Organization Name:LISA D. STINSON, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-638-1667
Mailing Address - Street 1:3585 VAN TEYLINGEN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-4875
Mailing Address - Country:US
Mailing Address - Phone:719-638-1667
Mailing Address - Fax:866-753-0714
Practice Address - Street 1:3585 VAN TEYLINGEN DR
Practice Address - Street 2:SUITE A
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-4875
Practice Address - Country:US
Practice Address - Phone:719-638-1667
Practice Address - Fax:866-753-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3272251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health