MEDICARE: MS. LISA M JUSTIS LCSW, CTS

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	1041C0700X	Clinical Social Worker	993053	CO

General Provider Information

NPI Number	:	1790834562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA M JUSTIS LCSW, CTS

Provider Business Mailing Address
First Line	:	1604 GAYLORD ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1207
Country	:	US
Telephone Number	:	303-832-3910
Fax Number	:	866-295-8869

Provider Business Practice Location Address
First Line	:	1604 GAYLORD ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1207
Country	:	US
Telephone Number	:	303-832-3910
Fax Number	:	866-295-8869

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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