Provider Demographics
NPI:1982195251
Name:PEBLEY, KATHYE GENE (MA, LPC, CAS)
Entity Type:Individual
Prefix:
First Name:KATHYE
Middle Name:GENE
Last Name:PEBLEY
Suffix:
Gender:F
Credentials:MA, LPC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2033
Mailing Address - Country:US
Mailing Address - Phone:719-550-1011
Mailing Address - Fax:719-550-1531
Practice Address - Street 1:5160 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2033
Practice Address - Country:US
Practice Address - Phone:719-550-1011
Practice Address - Fax:719-550-1531
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0005833101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty