Provider Demographics
NPI:1750579579
Name:LIZA YORK, PH.D., LPPC
Entity type:Organization
Organization Name:LIZA YORK, PH.D., LPPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:L
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-875-4158
Mailing Address - Street 1:703 3RD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5996
Mailing Address - Country:US
Mailing Address - Phone:303-875-4158
Mailing Address - Fax:303-776-7631
Practice Address - Street 1:703 3RD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5996
Practice Address - Country:US
Practice Address - Phone:303-875-4158
Practice Address - Fax:303-776-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2475103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty