Provider Demographics
NPI:1710272406
Name:ROMSTAD, KATHRYN FAY (LPC CAC III)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:FAY
Last Name:ROMSTAD
Suffix:
Gender:F
Credentials:LPC CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S TEJON ST
Mailing Address - Street 2:SUITE 1107
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2216
Mailing Address - Country:US
Mailing Address - Phone:719-291-8740
Mailing Address - Fax:
Practice Address - Street 1:121 S TEJON ST
Practice Address - Street 2:SUITE 1107
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2216
Practice Address - Country:US
Practice Address - Phone:719-291-8740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO433101YA0400X
CO4108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional