MEDICARE: MRS. LISA MICHELLE TEMPLETON PH.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	PSY - 3071	CO

General Provider Information

NPI Number	:	1588780613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MICHELLE TEMPLETON PH.D.

Provider Business Mailing Address
First Line	:	1006 DEPOT HILL RD
Second Line	:	STE D
City	:	BROOMFIELD
State	:	CO
Zip	:	80020-6741
Country	:	US
Telephone Number	:	303-514-4111
Fax Number	:

Provider Business Practice Location Address
First Line	:	8670 WOLFF CT STE 130
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80031-3692
Country	:	US
Telephone Number	:	303-514-4111
Fax Number	:	303-430-5306

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	11/23/2016

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