Provider Demographics
NPI:1073868022
Name:LUETKEHANS, KATHRYN H (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:H
Last Name:LUETKEHANS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 E 1ST ST STE 226
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2804
Mailing Address - Country:US
Mailing Address - Phone:425-922-8394
Mailing Address - Fax:
Practice Address - Street 1:4169 POSSESSION SHORES RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-8921
Practice Address - Country:US
Practice Address - Phone:360-362-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO757244Medicaid