Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 0015020 | CO |
NPI | 1003325234 |
---|---|
Provider Name | Katrina Whitehead |
First Address | Broomfield, CO 80020-7062 |
Second Address | Broomfield, CO 80020-7062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2017 |
Last Update Date | 19/09/2017 |