Provider Demographics
NPI:1720516230
Name:DOUGLAS, KAITLIN (MS, LMFT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2625 REDWING RD STE 175
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2625 REDWING RD STE 175
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6324
Practice Address - Country:US
Practice Address - Phone:970-613-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-28
Last Update Date:2017-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1378106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist