Provider Demographics
NPI:1619983269
Name:LANDIS, LAURA JANE (MA, LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JANE
Last Name:LANDIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W S BOULDER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1194
Mailing Address - Country:US
Mailing Address - Phone:720-868-9641
Mailing Address - Fax:
Practice Address - Street 1:225 W S BOULDER RD STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1194
Practice Address - Country:US
Practice Address - Phone:720-868-9641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional