Provider Demographics
NPI:1659007003
Name:KETCHUM, KATE GUEST (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:GUEST
Last Name:KETCHUM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:GUEST
Other - Last Name:KETCHUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2236 E STANWYK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3798
Mailing Address - Country:US
Mailing Address - Phone:918-606-5990
Mailing Address - Fax:
Practice Address - Street 1:7200 S ALTON WAY STE A250
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2247
Practice Address - Country:US
Practice Address - Phone:720-441-3714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health