Provider Demographics
NPI:1982323457
Name:KHRESTSOV, KATHERINE MARIE MARKHAM (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE MARKHAM
Last Name:KHRESTSOV
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16035 TABLE MOUNTAIN PKWY
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1642
Mailing Address - Country:US
Mailing Address - Phone:303-997-1459
Mailing Address - Fax:
Practice Address - Street 1:16035 TABLE MOUNTAIN PKWY
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-1642
Practice Address - Country:US
Practice Address - Phone:303-931-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
COCSW.099233371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical