Provider Demographics
NPI:1821832445
Name:PELLETIER, KATHRYN (LMFTA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 FLATIRON BLVD UNIT 4034
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8394
Mailing Address - Country:US
Mailing Address - Phone:713-653-3468
Mailing Address - Fax:
Practice Address - Street 1:4155 E JEWELL AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4504
Practice Address - Country:US
Practice Address - Phone:720-507-7548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist