Individual
LISA A BOYUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2121 S ONEIDA ST STE 336, DENVER, CO 80224-2552
(303) 718-1503
Mailing address
2047 S MILWAUKEE ST APT 5, DENVER, CO 80210-3553
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
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