Individual
LISA A BOYUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1975
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11238397
CAQH PROVIDER ID
CO
01
—
BOB54745
ECT PROVIDER ID
CO
Enumeration date
10/12/2006
Last updated
07/08/2007
Update your record
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