Provider Demographics
NPI:1942700422
Name:MARR, LISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MARR
Suffix:
Gender:F
Credentials:PSYD
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 882
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80480-0882
Mailing Address - Country:US
Mailing Address - Phone:720-810-1386
Mailing Address - Fax:
Practice Address - Street 1:312 5TH STREET
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:CO
Practice Address - Zip Code:80480
Practice Address - Country:US
Practice Address - Phone:970-457-0618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
COPSY.0004733103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist