Provider Demographics
NPI:1932120425
Name:UZZILIA STAUDER, LISA M (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:UZZILIA STAUDER
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 1:2045 SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-1921
Mailing Address - Country:US
Mailing Address - Phone:719-342-0898
Mailing Address - Fax:
Practice Address - Street 1:815 N NEVADA AVE
Practice Address - Street 2:210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4726
Practice Address - Country:US
Practice Address - Phone:719-342-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional