Provider Demographics
NPI:1376790337
Name:DALTHORP, KATE (MA)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:DALTHORP
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19000
Mailing Address - Street 2:PMB 240
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620
Mailing Address - Country:US
Mailing Address - Phone:970-926-8558
Mailing Address - Fax:970-926-6845
Practice Address - Street 1:90 LARIAT LOOP
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81620
Practice Address - Country:US
Practice Address - Phone:970-926-8558
Practice Address - Fax:970-926-6845
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6139101YA0400X
CO3135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)