Provider Demographics
NPI:1336403492
Name:ELISSA I. GEASE PHD LLC
Entity Type:Organization
Organization Name:ELISSA I. GEASE PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:I
Authorized Official - Last Name:GEASE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-462-0853
Mailing Address - Street 1:9482 W BALTIC CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2201
Mailing Address - Country:US
Mailing Address - Phone:303-980-6164
Mailing Address - Fax:
Practice Address - Street 1:950 WADSWORTH BLVD
Practice Address - Street 2:200
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-4591
Practice Address - Country:US
Practice Address - Phone:303-462-0853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO890103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609898501OtherINDIVIDUAL NPI
R21350Medicare UPIN
C95475Medicare PIN