Provider Demographics
NPI:1700975166
Name:EISWERTH-COX, LORA CATHERINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:CATHERINE
Last Name:EISWERTH-COX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4736
Mailing Address - Country:US
Mailing Address - Phone:303-910-2893
Mailing Address - Fax:
Practice Address - Street 1:6500 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4736
Practice Address - Country:US
Practice Address - Phone:303-910-2893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2178103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO680008437OtherRAILROAD MEDICARE
CO07021785Medicaid
CO680008437OtherRAILROAD MEDICARE
CO67346Medicare PIN
CO07021785Medicaid