Provider Demographics
NPI:1598807638
Name:LAROSE, LISA RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:LAROSE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 E COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3776
Mailing Address - Country:US
Mailing Address - Phone:719-634-1825
Mailing Address - Fax:
Practice Address - Street 1:961 E COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3776
Practice Address - Country:US
Practice Address - Phone:719-634-1825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional