Provider Demographics
NPI:1588797336
Name:HARRISON, LELA (LCSW, LAC, MAC)
Entity Type:Individual
Prefix:
First Name:LELA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LCSW, LAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 W 120TH AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5606
Mailing Address - Country:US
Mailing Address - Phone:303-578-8320
Mailing Address - Fax:
Practice Address - Street 1:8461 TURNPIKE DR STE 207
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-4379
Practice Address - Country:US
Practice Address - Phone:303-578-8320
Practice Address - Fax:303-590-9627
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000854101YA0400X
CA248821041C0700X
CO099232351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)