Healthcare Provider Details

I. General information

NPI: 1093670036
Provider Name (Legal Business Name): ELIZABETH WYNN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2356 MEADOWS BLVD STE 310B
CASTLE ROCK CO
80109-8516
US

IV. Provider business mailing address

2356 MEADOWS BLVD STE 310B
CASTLE ROCK CO
80109-8516
US

V. Phone/Fax

Practice location:
  • Phone: 720-330-1460
  • Fax: 720-703-9028
Mailing address:
  • Phone: 720-330-1460
  • Fax: 720-703-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0023211
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: