Provider Demographics
NPI:1750168175
Name:WATERMAN, KATHERINE MARIE (MC, LPC)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARIE
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:RYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4025 RAWLINS ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1900
Mailing Address - Country:US
Mailing Address - Phone:307-426-4797
Mailing Address - Fax:
Practice Address - Street 1:1413 W 29TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2403
Practice Address - Country:US
Practice Address - Phone:970-744-6342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional