Provider Demographics
NPI:1508188749
Name:WOODCOCK-BURROUGHS, LISA JO (PHD LP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JO
Last Name:WOODCOCK-BURROUGHS
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 SPIREROCK PATH
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2915
Mailing Address - Country:US
Mailing Address - Phone:517-304-0059
Mailing Address - Fax:
Practice Address - Street 1:1905 SPIREROCK PATH
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2915
Practice Address - Country:US
Practice Address - Phone:517-304-0059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1617946103TC0700X
MI6301015109REN20103TC0700X
COPSY.0005442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical