Provider Demographics
NPI:1275908402
Name:WOODWARD, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4159 LOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1658
Mailing Address - Country:US
Mailing Address - Phone:303-458-7220
Mailing Address - Fax:303-477-7559
Practice Address - Street 1:4159 LOWELL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1658
Practice Address - Country:US
Practice Address - Phone:303-458-7220
Practice Address - Fax:303-477-7559
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014973101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health