Healthcare Provider Details

I. General information

NPI: 1548591878
Provider Name (Legal Business Name): LISA PENDLETON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 BOARDWALK DR SUITE 100
FORT COLLINS CO
80525-5945
US

IV. Provider business mailing address

2001 S SHIELDS ST BUILDING D, STE 203
FORT COLLINS CO
80526-1827
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-4580
  • Fax: 970-797-2859
Mailing address:
  • Phone: 970-493-4580
  • Fax: 970-493-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10267
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: