Provider Demographics
NPI:1619266327
Name:KATZ, GENE IRA (MS, DABS)
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:IRA
Last Name:KATZ
Suffix:
Gender:M
Credentials:MS, DABS
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 17756
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-0756
Mailing Address - Country:US
Mailing Address - Phone:720-339-8174
Mailing Address - Fax:
Practice Address - Street 1:5650 GREENWOOD PLAZA BLVD
Practice Address - Street 2:SUITE 137
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2307
Practice Address - Country:US
Practice Address - Phone:720-339-8174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11170OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES, DIVISION OF REGISTRATIONS