MEDICARE: TONYA WOODSON MS, LPC, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	7307	CO
2	101YM0800X	Mental Health Counselor	LPC.0018705	CO

General Provider Information

NPI Number	:	1053698811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA WOODSON MS, LPC, LAC

Provider Business Mailing Address
First Line	:	503 N MAIN ST STE 648
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-3174
Country	:	US
Telephone Number	:	719-214-9417
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 N MAIN ST STE 648
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-3174
Country	:	US
Telephone Number	:	719-214-9417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	06/03/2026

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