Provider Demographics
NPI:1396521563
Name:KALLIO, NATARAJA (MA, LPCC)
Entity type:Individual
Prefix:
First Name:NATARAJA
Middle Name:
Last Name:KALLIO
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3986 PROMONTORY CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1000
Mailing Address - Country:US
Mailing Address - Phone:303-483-8405
Mailing Address - Fax:
Practice Address - Street 1:3986 PROMONTORY CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1000
Practice Address - Country:US
Practice Address - Phone:303-483-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0020330101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health