Provider Demographics
NPI:1982723722
Name:WALNOFER, LAURA (LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WALNOFER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:TROMBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1 EL PUEBLO RANCH WAY
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81006-2103
Mailing Address - Country:US
Mailing Address - Phone:719-404-1127
Mailing Address - Fax:719-404-1321
Practice Address - Street 1:1 EL PUEBLO RANCH WAY
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81006-2103
Practice Address - Country:US
Practice Address - Phone:719-404-1127
Practice Address - Fax:719-404-1321
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC3165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60788224Medicaid