Provider Demographics
NPI:1184323081
Name:RUTLEDGE, LARA KATHERINE (MA, LPCC, ATR-P)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:KATHERINE
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:MA, LPCC, ATR-P
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:KATHERINE
Other - Last Name:FAIRBANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4212 PRAIRIE FIRE CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6414
Mailing Address - Country:US
Mailing Address - Phone:303-704-2405
Mailing Address - Fax:
Practice Address - Street 1:4212 PRAIRIE FIRE CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6414
Practice Address - Country:US
Practice Address - Phone:303-704-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0019416101YM0800X
22-333221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health