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General NPI Number Information
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NPI Number | 1508188749
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Entity Type | Individual
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Provider Name | LISA JO WOODCOCK-BURROUGHS PH.D. LP
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Gender | Female
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Dates
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Enumeration Date | 02/15/2010
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 1905 SPIREROCK PATH
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-2915
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Country | US
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Telephone | 517-304-0059
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 SPIREROCK PATH
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-2915
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Country | US
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Telephone | 517-304-0059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | L1617946
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301015109REN20
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY.0005442
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License Number State | CO
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