Provider Demographics
NPI:1336249390
Name:SHANE, ELIZABETH LUCILLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LUCILLE
Last Name:SHANE
Suffix:
Gender:F
Credentials:PSYD
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Mailing Address - Street 1:425 SOUTH CHERRY STREET
Mailing Address - Street 2:#140
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246
Mailing Address - Country:US
Mailing Address - Phone:303-329-6586
Mailing Address - Fax:303-388-3896
Practice Address - Street 1:425 SOUTH CHERRY STREET
Practice Address - Street 2:#140
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246
Practice Address - Country:US
Practice Address - Phone:303-329-6586
Practice Address - Fax:303-388-3896
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO2048103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07020480Medicaid
CO07020480Medicaid