Provider Demographics
NPI:1912341983
Name:LISA M. VONDERHAAR, PH.D.,LLC
Entity Type:Organization
Organization Name:LISA M. VONDERHAAR, PH.D.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARET
Authorized Official - Last Name:VONDERHAAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-531-0574
Mailing Address - Street 1:10291 CHIPPEWA CIR
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9596
Mailing Address - Country:US
Mailing Address - Phone:970-531-0574
Mailing Address - Fax:
Practice Address - Street 1:10291 CHIPPEWA CIR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9596
Practice Address - Country:US
Practice Address - Phone:970-531-0574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2106103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA101010Medicare PIN