Provider Demographics
NPI:1457684938
Name:LASSEN, ELIZABETH WHITLEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:WHITLEY
Last Name:LASSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3194
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:CO
Mailing Address - Zip Code:80466-3194
Mailing Address - Country:US
Mailing Address - Phone:720-254-1389
Mailing Address - Fax:
Practice Address - Street 1:1762 WESTWOOD BLVD STE 310
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5641
Practice Address - Country:US
Practice Address - Phone:424-293-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004381103TC0700X
CAPSY25272103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical