Provider Demographics
NPI:1932375748
Name:OWENS-TUCKER, KATHERINE ROSE (MA LPC CACI)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ROSE
Last Name:OWENS-TUCKER
Suffix:
Gender:F
Credentials:MA LPC CACI
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ROSE
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2316 S HARLAN CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227
Mailing Address - Country:US
Mailing Address - Phone:303-810-1779
Mailing Address - Fax:
Practice Address - Street 1:1521 S PEARL ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210
Practice Address - Country:US
Practice Address - Phone:303-810-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6346101YA0400X
CO2361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)