Provider Demographics
NPI:1093190753
Name:APODACA, KATHLEEN EVE (MS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:EVE
Last Name:APODACA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 4500 S
Mailing Address - Street 2:SUITE F 125
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2995
Mailing Address - Country:US
Mailing Address - Phone:801-268-1564
Mailing Address - Fax:801-268-1565
Practice Address - Street 1:525 E 4500 S
Practice Address - Street 2:SUITE F 125
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-268-1564
Practice Address - Fax:801-268-1565
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6048491-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6048491-6004OtherSTATE LICENSE FOR CMHC