Provider Demographics
NPI:1265545909
Name:AZAR, KATHLEEN S (LCSW, CACIII)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:S
Last Name:AZAR
Suffix:
Gender:F
Credentials:LCSW, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:COLO. SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-473-5341
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIRCLE
Practice Address - Street 2:BLDG. 7500
Practice Address - City:FT. CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-8376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4200101YA0400X
CO9916481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical