Provider Demographics
NPI:1649338963
Name:STRAIGHT, LISA MARIE (MA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:STRAIGHT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14836 COLUMBINE CT
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-7346
Mailing Address - Country:US
Mailing Address - Phone:720-838-6568
Mailing Address - Fax:303-524-9515
Practice Address - Street 1:12500 FIRST ST
Practice Address - Street 2:SUITE 6
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3800
Practice Address - Country:US
Practice Address - Phone:720-838-6568
Practice Address - Fax:303-524-9515
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health