Provider Demographics
NPI:1851643340
Name:GERTZEN, LISA (MA,MFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GERTZEN
Suffix:
Gender:F
Credentials:MA,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10846 TOWERBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-6624
Mailing Address - Country:US
Mailing Address - Phone:720-209-5138
Mailing Address - Fax:
Practice Address - Street 1:10846 TOWERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-6624
Practice Address - Country:US
Practice Address - Phone:720-209-5138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14056251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health