Healthcare Provider Details

I. General information

NPI: 1982528774
Provider Name (Legal Business Name): LANDRY ELISE WOODWARD LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4790 TABLE MESA DR
BOULDER CO
80305-5600
US

IV. Provider business mailing address

4790 TABLE MESA DR
BOULDER CO
80305-5600
US

V. Phone/Fax

Practice location:
  • Phone: 254-246-0581
  • Fax:
Mailing address:
  • Phone: 254-246-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0024721
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: