Healthcare Provider Details

I. General information

NPI: 1366807117
Provider Name (Legal Business Name): LISA YORDY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 GUNPARK DR STE 370-206
BOULDER CO
80301-3346
US

IV. Provider business mailing address

6525 GUNPARK DR STE 370-206
BOULDER CO
80301-3346
US

V. Phone/Fax

Practice location:
  • Phone: 303-475-4755
  • Fax:
Mailing address:
  • Phone: 303-475-4755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09923981
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: