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General NPI Number Information
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NPI Number | 1023010691
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Entity Type | Individual
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Provider Name | JONATHAN MARK LIPSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 06/11/2009
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Provider Practice Location Address
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Address Line | 1746 COLE BLVD BUILDING 21, SUITE 295
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City | LAKEWOOD
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State | CO
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Zip | 80401-3208
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Country | US
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Telephone | 303-916-1952
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Fax | 303-278-4981
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Provider Business Mailing Address
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Address Line | PO BOX 478
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City | CONIFER
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State | CO
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Zip | 80433-0478
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Country | US
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Telephone | 303-916-1952
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Fax | 303-278-4981
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2129
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 2129
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License Number State | CO
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