Provider Demographics
NPI:1023528601
Name:KATHLEEN RENEE KOELSCH, LLC
Entity type:Organization
Organization Name:KATHLEEN RENEE KOELSCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:KOELSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:303-435-3828
Mailing Address - Street 1:7163 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5648
Mailing Address - Country:US
Mailing Address - Phone:303-435-3828
Mailing Address - Fax:
Practice Address - Street 1:2627 REDWING RD STE 325
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6355
Practice Address - Country:US
Practice Address - Phone:303-435-3828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty