Provider Demographics
NPI:1619308194
Name:BRYDON, KATIE (LCSW, LAC,MAC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BRYDON
Suffix:
Gender:F
Credentials:LCSW, LAC,MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11857 KEOUGH DR
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1221
Mailing Address - Country:US
Mailing Address - Phone:720-401-2340
Mailing Address - Fax:
Practice Address - Street 1:10050 RALSTON RD # 1 B/E
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-8000
Practice Address - Country:US
Practice Address - Phone:720-401-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
COCSW.099240331041C0700X
COACD0000390101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)