Individual provider · Type 1 NPI

Lisa Wallace, LPC

Professional Counselor · Boulder, CO

NPI number 1336779925 Active

Practice location

2769 Iris Ave Ste 107
Boulder, CO 80304-4405

Call (970) 368-9185 Map

Mailing address

1600 Bradley Ct
Boulder, CO 80305-7310

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor Primary 101YP2500X0015978 (CO)

Professional Counselor: Definition to come...

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About NPI 1336779925

Lisa Wallace, LPC's National Provider Identifier is 1336779925, issued on Jan 22, 2020. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Boulder, CO. The record was last updated on Jan 22, 2020.