Provider Demographics
NPI:1982036240
Name:JINICH, CATHEY (MA)
Entity Type:Individual
Prefix:
First Name:CATHEY
Middle Name:
Last Name:JINICH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-1208
Mailing Address - Country:US
Mailing Address - Phone:970-252-3200
Mailing Address - Fax:970-252-3208
Practice Address - Street 1:710 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2244
Practice Address - Country:US
Practice Address - Phone:970-641-0229
Practice Address - Fax:970-641-2949
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
COLPC0013384101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor