Provider Demographics
NPI:1285265801
Name:MATHIS, KATHRYN MARIE (LPC, RPT)
Entity type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:MARIE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 S LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2523
Mailing Address - Country:US
Mailing Address - Phone:432-741-0414
Mailing Address - Fax:
Practice Address - Street 1:8101 SHAFFER PKWY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4111
Practice Address - Country:US
Practice Address - Phone:432-741-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013584101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor