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General NPI Number Information
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NPI Number | 1659007003
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Entity Type | Individual
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Provider Name | KATE GUEST KETCHUM MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 7200 S ALTON WAY STE A250
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City | CENTENNIAL
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State | CO
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Zip | 80112-2247
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Country | US
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Telephone | 720-441-3714
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Fax |
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Provider Business Mailing Address
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Address Line | 2236 E STANWYK DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3798
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Country | US
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Telephone | 918-606-5990
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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 | LPC.0017834
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License Number State | CO
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