Provider Demographics
NPI:1912276312
Name:ELLARD, KATE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:ELLARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:HARDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5412 IDYLWILD TRL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3523
Mailing Address - Country:US
Mailing Address - Phone:720-310-5125
Mailing Address - Fax:
Practice Address - Street 1:5412 IDYLWILD TRL
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:720-310-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9925541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO992554OtherLCSW
45-3933692OtherEIN