Individual
JONATHAN MARK LIPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1746 COLE BLVD, BUILDING 21, SUITE 295, LAKEWOOD, CO 80401-3208
(303) 916-1952
(303) 278-4981
Mailing address
PO BOX 478, CONIFER, CO 80433-0478
(303) 916-1952
(303) 278-4981
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2129
CO
103TH0100X
Health Service Psychologist
2129
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07021298
—
CO
01
—
LIA53624
BLUE CROSS BLUE SHIELD
—
Enumeration date
08/12/2005
Last updated
06/11/2009
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