Healthcare Provider Details

I. General information

NPI: 1851799563
Provider Name (Legal Business Name): LISA ANDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 WILMINGTON DR UNIT 101
FORT COLLINS CO
80528-6103
US

IV. Provider business mailing address

3341 PINERIDGE PL
FORT COLLINS CO
80525-2891
US

V. Phone/Fax

Practice location:
  • Phone: 505-620-9686
  • Fax:
Mailing address:
  • Phone: 505-620-9686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09931239
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08302
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: