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General NPI Number Information
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NPI Number | 1427867662
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Entity Type | Individual
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Provider Name | CLARISSA LYLE LPCC
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Gender | Female
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 109 BROOKDALE AVE STE 9
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City | BUENA VISTA
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State | CO
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Zip | 81211-8911
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Country | US
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Telephone | 303-237-6568
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Fax |
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Provider Business Mailing Address
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Address Line | 505 PARK LANE
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City | BUENA VISTA
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State | CO
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Zip | 81211
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Country | US
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Telephone | 307-220-6867
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0022879
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License Number State | CO
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