Provider Demographics
NPI:1548740640
Name:WIDLUND, KATHLEEN (LPCC, MA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WIDLUND
Suffix:
Gender:F
Credentials:LPCC, 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 1342
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-1342
Mailing Address - Country:US
Mailing Address - Phone:612-382-3532
Mailing Address - Fax:
Practice Address - Street 1:12835 E ARAPAHOE RD STE 440
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3940
Practice Address - Country:US
Practice Address - Phone:612-382-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0016111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional