Healthcare Provider Details

I. General information

NPI: 1376781807
Provider Name (Legal Business Name): LEONARD EDWARD WOODSON III MASTER OF COUNSELING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAIN ST STE 648
PUEBLO CO
81003-3174
US

IV. Provider business mailing address

503 N MAIN ST STE 648
PUEBLO CO
81003-3174
US

V. Phone/Fax

Practice location:
  • Phone: 719-214-9417
  • Fax:
Mailing address:
  • Phone: 719-214-9417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9182
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: