Provider Demographics
NPI:1790083491
Name:LOZANO, LISA M (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LOZANO
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:PO BOX 3883
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3883
Mailing Address - Country:US
Mailing Address - Phone:307-682-6699
Mailing Address - Fax:307-687-7243
Practice Address - Street 1:1401 W 2ND ST
Practice Address - Street 2:SUITE #1
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3333
Practice Address - Country:US
Practice Address - Phone:307-682-6699
Practice Address - Fax:307-687-7243
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYPPC-458OtherSTATE LICENSE NUMBER