Provider Demographics
NPI:1053758078
Name:BHAGATRAM-JACKSON, KATHRYN (LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BHAGATRAM-JACKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATIA
Other - Middle Name:
Other - Last Name:BHAGATRAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:300 MAIN ST STE 306
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2404
Mailing Address - Country:US
Mailing Address - Phone:970-279-3377
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2404
Practice Address - Country:US
Practice Address - Phone:970-279-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2025-02-04
Deactivation Date:2014-01-13
Deactivation Code:
Reactivation Date:2022-07-22
Provider Licenses
StateLicense IDTaxonomies
COLPC.0020524101YP2500X
101YS0200X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health