Provider Demographics
NPI:1154127074
Name:MAYNARD, LISA GAIL (MS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAIL
Last Name:MAYNARD
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8517 EATON ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-1325
Mailing Address - Country:US
Mailing Address - Phone:407-310-0507
Mailing Address - Fax:
Practice Address - Street 1:8517 EATON ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-1325
Practice Address - Country:US
Practice Address - Phone:407-310-0507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0023097101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty