MEDICARE: DR. COLLEEN MARIE LIX PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY25656	CA

General Provider Information

NPI Number	:	1225471253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN MARIE LIX PSY.D.

Provider Business Mailing Address
First Line	:	2711 ALCATRAZ AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2726
Country	:	US
Telephone Number	:	510-220-2363
Fax Number	:

Provider Business Practice Location Address
First Line	:	2711 ALCATRAZ AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2726
Country	:	US
Telephone Number	:	510-220-2363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	01/06/2026

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