MEDICARE: MRS. LISA S. LOCKWOOD LMFT

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
1	106H00000X	Marriage & Family Therapist	329	CO

General Provider Information

NPI Number	:	1265599229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA S. LOCKWOOD LMFT

Provider Business Mailing Address
First Line	:	1115 ELKTON DR STE 300
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3597
Country	:	US
Telephone Number	:	719-527-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 ELKTON DR STE 300
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3597
Country	:	US
Telephone Number	:	719-574-6562
Fax Number	:	719-570-0386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	03/22/2013

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