Healthcare Provider Details

I. General information

NPI: 1558966168
Provider Name (Legal Business Name): KATHRYN ANNE SCHWARZ MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 10TH ST
BOULDER CO
80302-7261
US

IV. Provider business mailing address

2818 13TH ST
BOULDER CO
80304-3518
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 303-440-5140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0016724
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: