Provider Demographics
NPI:1043467046
Name:AUSTIN, KATHERINE HUNT IV
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HUNT
Last Name:AUSTIN
Suffix:IV
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:HUNT
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT, LPC, LAC
Mailing Address - Street 1:2305 CANYON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5651
Mailing Address - Country:US
Mailing Address - Phone:303-917-5418
Mailing Address - Fax:
Practice Address - Street 1:2305 CANYON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5651
Practice Address - Country:US
Practice Address - Phone:303-917-5418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1085106H00000X
CO213101YA0400X
CO6179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional