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General NPI Number Information
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NPI Number | 1255522843
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Entity Type | Individual
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Provider Name | CATHERINE J ILIFF
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Gender | Female
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 1401 N ELIZABETH ST STE B
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City | PUEBLO
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State | CO
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Zip | 81003-2158
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Country | US
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Telephone | 720-884-7830
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Fax |
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Provider Business Mailing Address
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Address Line | 1343 E 13TH ST
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City | PUEBLO
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State | CO
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Zip | 81001-3115
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Country | US
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Telephone | 719-225-8584
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6235
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License Number State | CO
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