Healthcare Provider Details

I. General information

NPI: 1982108858
Provider Name (Legal Business Name): KATHLEEN MALONE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 VALMONT RD STE 210
BOULDER CO
80301-1360
US

IV. Provider business mailing address

1789 YELLOW PINE AVE
BOULDER CO
80304-4367
US

V. Phone/Fax

Practice location:
  • Phone: 303-250-5359
  • Fax: 720-909-6373
Mailing address:
  • Phone: 303-250-5359
  • Fax: 720-909-6373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15578
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0015399
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: