Provider Demographics
NPI:1649756768
Name:KENDRICK, ELIZABETH KATE
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:KATE
Last Name:KENDRICK
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 1:635 GOOSEBERRY DR UNIT 1506
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6446
Mailing Address - Country:US
Mailing Address - Phone:303-485-9428
Mailing Address - Fax:
Practice Address - Street 1:709 3RD AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5926
Practice Address - Country:US
Practice Address - Phone:303-485-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0007318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health