Provider Demographics
NPI:1609898501
Name:GEASE, ELISSA I (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:I
Last Name:GEASE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 WADSWORTH BLVD
Mailing Address - Street 2:#200
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-4542
Mailing Address - Country:US
Mailing Address - Phone:303-462-0853
Mailing Address - Fax:303-233-7898
Practice Address - Street 1:950 WADSWORTH BLVD
Practice Address - Street 2:#200
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-4591
Practice Address - Country:US
Practice Address - Phone:303-462-0853
Practice Address - Fax:303-233-7898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO890103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO213500001Medicare UPIN
CO1C 95476Medicare PIN