1295398139 NPI number — CHRISTINE MARGARET ELIZABETH LEWALLEN LPC

Table of content: CHRISTINE MARGARET ELIZABETH LEWALLEN LPC (NPI 1295398139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295398139 NPI number — CHRISTINE MARGARET ELIZABETH LEWALLEN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWALLEN
Provider First Name:
CHRISTINE
Provider Middle Name:
MARGARET ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETERSEN
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295398139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4851 INDEPENDENCE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEAT RIDGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80033-6715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-432-5312
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31207 KEATS WAY STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERGREEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80439-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-425-0300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC.0019368 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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