Provider Demographics
NPI:1982108858
Name:MALONE, KATHLEEN D (LPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:MALONE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 EASY RIDER LN STE 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-8411
Mailing Address - Country:US
Mailing Address - Phone:303-250-5359
Mailing Address - Fax:303-250-5359
Practice Address - Street 1:1517 EASY RIDER LN STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-8411
Practice Address - Country:US
Practice Address - Phone:303-250-5359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15578101YP2500X
COLPC0015399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15578OtherLPCC