Provider Demographics
NPI:1154672194
Name:KURTH, CATHERINE LISA
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:LISA
Last Name:KURTH
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:KURTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1918 S LEMAY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1294
Mailing Address - Country:US
Mailing Address - Phone:970-482-7771
Mailing Address - Fax:970-482-7776
Practice Address - Street 1:1918 S LEMAY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1294
Practice Address - Country:US
Practice Address - Phone:970-482-7771
Practice Address - Fax:970-482-7776
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional