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General NPI Number Information
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NPI Number | 1639477300
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Entity Type | Individual
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Provider Name | ELIZABETH S REISEN MSW, LCSW, LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 1225 KEN PRATT BLVD UNIT 137
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City | LONGMONT
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State | CO
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Zip | 80501-9000
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Country | US
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Telephone | 720-727-7373
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 PEARL CV
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City | ROUND ROCK
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State | TX
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Zip | 78681-1967
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Country | US
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Telephone | 303-727-7373
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT1178
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW2105
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 106795
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License Number State | TX
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