MEDICARE: LISA PENDLETON M.S.

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	10267	CO

General Provider Information

NPI Number	:	1548591878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA PENDLETON M.S.

Provider Business Mailing Address
First Line	:	2001 S SHIELDS ST
Second Line	:	BUILDING D, STE 203
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1827
Country	:	US
Telephone Number	:	970-493-4580
Fax Number	:	970-493-4580

Provider Business Practice Location Address
First Line	:	4115 BOARDWALK DR
Second Line	:	SUITE 100
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5945
Country	:	US
Telephone Number	:	970-493-4580
Fax Number	:	970-797-2859

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

Provider Enumeration Date	:	01/27/2010
Last Update Date	:	05/30/2025

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