Healthcare Provider Details

I. General information

NPI: 1700034527
Provider Name (Legal Business Name): LORI CHRISTINE KUCHARSKI PHD, LMFT-S, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 SHASTA DR
COLORADO SPRINGS CO
80910-1920
US

IV. Provider business mailing address

1326 SHASTA DR
COLORADO SPRINGS CO
80910-1920
US

V. Phone/Fax

Practice location:
  • Phone: 719-360-2440
  • Fax:
Mailing address:
  • Phone: 719-360-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number848
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5205
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: