Provider Demographics
NPI:1992901201
Name:PHILLIPS, KATHERINE DOLORES (MA,LLC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DOLORES
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA,LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 S ACOMA ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-1507
Mailing Address - Country:US
Mailing Address - Phone:303-806-8806
Mailing Address - Fax:
Practice Address - Street 1:2929 S ACOMA ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-1507
Practice Address - Country:US
Practice Address - Phone:303-806-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC-8325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health