Provider Demographics
NPI:1811202419
Name:UNDERWOOD BRUNTZ, LAURIE LYNNETTE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:LYNNETTE
Last Name:UNDERWOOD BRUNTZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 W 29TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2459
Mailing Address - Country:US
Mailing Address - Phone:970-775-7061
Mailing Address - Fax:970-292-8194
Practice Address - Street 1:1440 W 29TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2459
Practice Address - Country:US
Practice Address - Phone:970-775-7061
Practice Address - Fax:970-292-8194
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional