Provider Demographics
NPI:1255522843
Name:ILIFF, CATHERINE J
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:J
Last Name:ILIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-3115
Mailing Address - Country:US
Mailing Address - Phone:719-225-8584
Mailing Address - Fax:
Practice Address - Street 1:1401 N ELIZABETH ST
Practice Address - Street 2:STE B
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2158
Practice Address - Country:US
Practice Address - Phone:720-884-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
CO6235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health