Individual provider · Type 1 NPI

Lisa M. Wallace, MA, LPC

Professional Counselor · Fort Collins, CO

NPI number 1124002571 Active

Practice location

4103 E Boardwalk Drive, Suite 202
Fort Collins, CO 80525-5930

Call (970) 817-4049 Map

Fax (877) 833-4460

Mailing address

PO Box 273338
Fort Collins, CO 80527-3338

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor 101YP2500X906 (WY)
Professional Counselor Primary 101YP2500X5913 (CO)

Professional Counselor: Definition to come...

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About NPI 1124002571

Lisa M. Wallace, MA, LPC's National Provider Identifier is 1124002571, issued on Nov 30, 2005. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Fort Collins, CO. The record was last updated on Dec 1, 2025.