| Doctor Name: | DR. LISA MARET VONDERHAAR |
| NPI Number: | 1114086410 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 2106 |
| Business Practice Address: | 689 E. Agate Ave. Granby, CO - 804460757 |
| Business Phone Number: | 9708870806 |
| Business Fax Number: | 9708870806 |
| Mailing Address: | Po Box 757, GRANBY |
| State: | CO |
| Postal Code: | 804460757 |
| Phone Number: | 9708870806 |
| Fax Number: | 9708870806 |
| NPI Enumeration Date: | 12/06/2006 |
| NPI Last Update Date: | 04/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 2106 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |