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NPI Code Detail

MEDICARE: LISA BRACHHOLD LCSW

MEDICARE:   LISA  BRACHHOLD  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker09924383CO

General Provider Information

NPI Number : 1194495515
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA BRACHHOLD LCSW
Provider Business Mailing Address
First Line : 4423 WHITE OAK CT
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-7770
Country : US
Telephone Number : 719-271-0114
Fax Number :
Provider Business Practice Location Address
First Line : 4423 WHITE OAK CT
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-7770
Country : US
Telephone Number : 719-271-0114
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2021
Last Update Date : 09/16/2021

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Directions to “ LISA BRACHHOLD LCSW” Practice Location

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