MEDICARE: MR. LEONARD EDWARD WOODSON III MASTER OF COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	9182	CO

General Provider Information

NPI Number	:	1376781807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEONARD EDWARD WOODSON III MASTER OF COUNSELING

Provider Business Mailing Address
First Line	:	503 N MAIN ST STE 648
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-3174
Country	:	US
Telephone Number	:	719-214-9417
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 N MAIN ST STE 648
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-3174
Country	:	US
Telephone Number	:	719-214-9417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	12/11/2025

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