Basic Information
| Provider Information | |||||||||
| NPI: | 1982036240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JINICH | ||||||||
| FirstName: | CATHEY | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1208 | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814021208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702523200 | ||||||||
| FaxNumber: | 9702523208 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 N TAYLOR ST | ||||||||
| Address2: | |||||||||
| City: | GUNNISON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812302244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706410229 | ||||||||
| FaxNumber: | 9706412949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2013 | ||||||||
| LastUpdateDate: | 11/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | LPC0013384 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.