Provider Demographics
NPI:1457700312
Name:WATSON, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 FILLMORE ST UNIT 150
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5001
Mailing Address - Country:US
Mailing Address - Phone:887-258-0288
Mailing Address - Fax:
Practice Address - Street 1:250 FILLMORE ST UNIT 150
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5001
Practice Address - Country:US
Practice Address - Phone:887-258-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI44871041C0700X
WA609925471041C0700X
CO099258851041C0700X, 1041C0700X
IA775071041C0700X
NE18241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical