Provider Demographics
NPI:1952074890
Name:KENIGSBERG, KATHRYN L (LPCC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:KENIGSBERG
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 54TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4478
Mailing Address - Country:US
Mailing Address - Phone:970-344-9129
Mailing Address - Fax:
Practice Address - Street 1:4665 W 20TH ST UNIT C1
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3221
Practice Address - Country:US
Practice Address - Phone:970-344-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0020130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health