Provider Demographics
NPI:1750977070
Name:LYSAGHT, EMMALYN (LPC)
Entity type:Individual
Prefix:
First Name:EMMALYN
Middle Name:
Last Name:LYSAGHT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EMMALYN
Other - Middle Name:
Other - Last Name:CLURMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1942 BROADWAY STE 314C
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5233
Mailing Address - Country:US
Mailing Address - Phone:720-615-0110
Mailing Address - Fax:
Practice Address - Street 1:1942 BROADWAY STE 314C
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5233
Practice Address - Country:US
Practice Address - Phone:720-615-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0017904101YM0800X
COLPC.0018745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health