Provider Demographics
NPI:1245600592
Name:TUTTLE, KATYE
Entity Type:Individual
Prefix:
First Name:KATYE
Middle Name:
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 S NELSON CIR
Mailing Address - Street 2:APT 205
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-1198
Mailing Address - Country:US
Mailing Address - Phone:508-410-5224
Mailing Address - Fax:
Practice Address - Street 1:1255 LEE ST
Practice Address - Street 2:APT 205
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4542
Practice Address - Country:US
Practice Address - Phone:508-410-5224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0014268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPCC.0014268Medicaid