Provider Demographics
NPI:1710323654
Name:ANTON, LISA (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:ANTON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 PYRAMID PL
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-7821
Mailing Address - Country:US
Mailing Address - Phone:620-408-5929
Mailing Address - Fax:
Practice Address - Street 1:7120 PYRAMID PL
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-7821
Practice Address - Country:US
Practice Address - Phone:620-408-5929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-19
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst