Provider Demographics
NPI:1790834562
Name:JUSTIS, LISA M (LCSW, CTS)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:JUSTIS
Suffix:
Gender:F
Credentials:LCSW, CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1207
Mailing Address - Country:US
Mailing Address - Phone:303-832-3910
Mailing Address - Fax:866-295-8869
Practice Address - Street 1:1604 GAYLORD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1207
Practice Address - Country:US
Practice Address - Phone:303-832-3910
Practice Address - Fax:866-295-8869
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9930531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical