Costello, Lisa Humphrey

Costello, Lisa Humphrey is an individual health care provider with primary practice located at 13123 E 16Th Ave , Aurora CO 80045-7106. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as her primary health care specialty. Costello, Lisa Humphrey can be contacted via phone (720) 777-1234.

Contact Information

Primary practice address
13123 E 16Th Ave Aurora CO 80045-7106
Phone: (720) 777-1234
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X PS01229 Rhode Island
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X PSY.0004029 Colorado

Profile Details

NPI number 1295022531
LBN Legal business name Costello, Lisa Humphrey
Credentials PH.D., NCSP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2011
Last updated Nov 19th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295022531 NPPES
Rhode Island Other PS01229 PROFESSIONAL LICENSE

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