Provider Demographics
NPI:1013218049
Name:KINGSFORD, ELIZA KATE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZA
Middle Name:KATE
Last Name:KINGSFORD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 PIMA CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-3970
Mailing Address - Country:US
Mailing Address - Phone:303-503-0090
Mailing Address - Fax:
Practice Address - Street 1:64 PIMA CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-3970
Practice Address - Country:US
Practice Address - Phone:303-503-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5423101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health