Basic Information
Provider Information
NPI: 1780875377
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOSCH
FirstName: KATHRYN
MiddleName: ADELL
NamePrefix:  
NameSuffix:  
Credential: M.ED, LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 220 RUSKIN DR
Address2:  
City: COLORADO SPRINGS
State: CO
PostalCode: 80910
CountryCode: US
TelephoneNumber: 7195726100
FaxNumber: 7195726080
Practice Location
Address1: 2864 S CIRCLE DRIVE
Address2: SUITE 600
City: COLORADO SPRINGS
State: CO
PostalCode: 80906
CountryCode: US
TelephoneNumber: 7193144260
FaxNumber: 7192646616
Other Information
ProviderEnumerationDate: 08/07/2007
LastUpdateDate: 05/29/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  N Behavioral Health & Social Service ProvidersCounselor 
101YP2500X6385COY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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