Provider Demographics
NPI:1477705978
Name:NACKOVIC PARKER, LISA M (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:NACKOVIC PARKER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:NACKOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5460 WARD RD STE 145
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1800
Mailing Address - Country:US
Mailing Address - Phone:303-968-0952
Mailing Address - Fax:
Practice Address - Street 1:5460 WARD RD UNIT 142
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1825
Practice Address - Country:US
Practice Address - Phone:303-968-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CO14701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30937809Medicaid
CO024683OtherKAISER COMMERCIAL NUMBER
CO30937809Medicaid