Provider Demographics
NPI:1831541226
Name:CLARKSON, KATELYN (LPC, CAC II)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:LPC, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 HILTON PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3565
Mailing Address - Country:US
Mailing Address - Phone:719-930-5667
Mailing Address - Fax:
Practice Address - Street 1:4570 HILTON PKWY STE 104
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3565
Practice Address - Country:US
Practice Address - Phone:719-930-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007959101YA0400X
CO0012493101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)