Provider Demographics
NPI:1831505486
Name:GONZALEZ, LIZBETH (SWC)
Entity type:Individual
Prefix:
First Name:LIZBETH
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 W COUNTY ROAD 54 E
Mailing Address - Street 2:
Mailing Address - City:BELLVUE
Mailing Address - State:CO
Mailing Address - Zip Code:80512-7122
Mailing Address - Country:US
Mailing Address - Phone:970-308-0473
Mailing Address - Fax:
Practice Address - Street 1:1301 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4374
Practice Address - Country:US
Practice Address - Phone:970-888-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONA00737225376K00000X
COSWC.0000000707104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No376K00000XNursing Service Related ProvidersNurse's Aide