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General NPI Number Information
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NPI Number | 1619983269
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Entity Type | Individual
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Provider Name | LAURA JANE LANDIS MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 225 W S BOULDER RD STE 103
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City | LOUISVILLE
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State | CO
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Zip | 80027-1194
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Country | US
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Telephone | 720-868-9641
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Fax |
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Provider Business Mailing Address
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Address Line | 225 W S BOULDER RD STE 103
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City | LOUISVILLE
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State | CO
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Zip | 80027-1194
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Country | US
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Telephone | 720-868-9641
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0011421
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License Number State | CO
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