Healthcare Provider Details

I. General information

NPI: 1114663226
Provider Name (Legal Business Name): ELIZABETH FRIAS LCSW-LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 IRIS PKWY
FREDERICK CO
80504-6412
US

IV. Provider business mailing address

203 S ROLLIE AVE
FORT LUPTON CO
80621-1508
US

V. Phone/Fax

Practice location:
  • Phone: 303-697-2583
  • Fax: 303-833-6515
Mailing address:
  • Phone: 303-892-6401
  • Fax: 303-286-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09928258
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002040
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: