Healthcare Provider Details

I. General information

NPI: 1205653342
Provider Name (Legal Business Name): KATELYN TAYLOR KIRK-PROVENCHER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 W OXFORD AVE
DENVER CO
80236-3108
US

IV. Provider business mailing address

3520 W OXFORD AVE
DENVER CO
80236-3108
US

V. Phone/Fax

Practice location:
  • Phone: 38-667-0663
  • Fax:
Mailing address:
  • Phone: 303-866-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY.0006530
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0006530
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: