Healthcare Provider Details

I. General information

NPI: 1033043872
Provider Name (Legal Business Name): LAURA MARIE COSTANZA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURIE COSTANZA LPCC

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 62ND AVE UNIT 1802
DENVER CO
80216-1495
US

IV. Provider business mailing address

1001 E 62ND AVE UNIT 1802
DENVER CO
80216-1495
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-7688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0022478
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: