Healthcare Provider Details

I. General information

NPI: 1164967295
Provider Name (Legal Business Name): KATHARINE RAGAN MA, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOMESTEAD DR APT 13
EDWARDS CO
81632-8158
US

IV. Provider business mailing address

500 HOMESTEAD DR APT 13
EDWARDS CO
81632-8158
US

V. Phone/Fax

Practice location:
  • Phone: 970-471-6600
  • Fax:
Mailing address:
  • Phone: 970-471-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0003022
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: