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NPI Code Detail

MEDICARE: MRS. LISA CERNICK MA, LPC

MEDICARE: MRS. LISA CERNICK MA, LPC
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
1101YM0800XMental Health Counselor3001CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13001OTHERCOLPC NUMBER

General Provider Information

NPI Number : 1366505349
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA CERNICK MA, LPC
Provider Business Mailing Address
First Line : 4371 E 72ND AVE
Second Line :
City : COMMERCE CITY
State : CO
Zip : 80022-1471
Country : US
Telephone Number : 303-853-3712
Fax Number : 303-289-6962
Provider Business Practice Location Address
First Line : 4371 E 72ND AVE
Second Line :
City : COMMERCE CITY
State : CO
Zip : 80022-1471
Country : US
Telephone Number : 303-853-3712
Fax Number : 303-289-6962
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 07/08/2007

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