Healthcare Provider Details

I. General information

NPI: 1063910131
Provider Name (Legal Business Name): LISA NELSON LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 W DARTMOUTH AVE STE 203
DENVER CO
80227-5516
US

IV. Provider business mailing address

2685 S PENNSYLVANIA ST
DENVER CO
80210-5723
US

V. Phone/Fax

Practice location:
  • Phone: 720-588-0836
  • Fax:
Mailing address:
  • Phone: 720-588-0836
  • Fax: 720-306-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LISA R NELSON
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 408-655-0711