Healthcare Provider Details

I. General information

NPI: 1750579579
Provider Name (Legal Business Name): LIZA YORK, PH.D., LPPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 3RD AVE SUITE C
LONGMONT CO
80501-5996
US

IV. Provider business mailing address

703 3RD AVE SUITE C
LONGMONT CO
80501-5996
US

V. Phone/Fax

Practice location:
  • Phone: 303-875-4158
  • Fax: 303-776-7631
Mailing address:
  • Phone: 303-875-4158
  • Fax: 303-776-7631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2475
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2475
License Number StateCO

VIII. Authorized Official

Name: DR. LIZA L YORK
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 303-875-4158