MEDICARE: LAURIE LYNNETTE UNDERWOOD BRUNTZ MA, LPC

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	101YP2500X	Professional Counselor	4861	CO

General Provider Information

NPI Number	:	1811202419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE LYNNETTE UNDERWOOD BRUNTZ MA, LPC

Provider Business Mailing Address
First Line	:	1440 W 29TH ST STE 100
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-2459
Country	:	US
Telephone Number	:	970-775-7061
Fax Number	:	970-292-8194

Provider Business Practice Location Address
First Line	:	1440 W 29TH ST STE 100
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-2459
Country	:	US
Telephone Number	:	970-775-7061
Fax Number	:	970-292-8194

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

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	07/28/2020

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