Individual provider Active NPI

Kathryn Wickman

  • Professional Counselor
  • Lakewood, CO
National Provider Identifier
1487042974
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC.0014096 Issued in CO
Practice address
3595 S Teller St
Lakewood, CO 80235-2014
Phone
(303) 425-0030
NPI assigned
Jan 6, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Professional Counselor 101YP2500X LPC.0014096 CO Primary

Addresses

Primary practice location

3595 S Teller St
Lakewood, CO 80235-2014

Mailing address

4851 Independence St
Suite 200
Wheat Ridge, CO 80033-6715
Phone (303) 425-0030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251031004186 CO Practitioner - Mental Health Counselor 5294224804 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4851 Independence St
Wheat Ridge, CO 80033-2243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LPC.0014096COMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson Center for Mental Health Mental Health CurrentSince Aug 14, 2025 Accepting new patients
Jefferson Center for Mental Health CurrentSince Aug 14, 2025 Accepting new patients

Locations

16280 W 64th Ave
Arvada, CO 80007
Phone (720) 898-1110

3595 S Teller St
Lakewood, CO 80235
Phone (303) 425-4950

9485 W Colfax Ave
Lakewood, CO 80215
Phone (303) 432-5200

3595 S Teller St
Ste 200
Lakewood, CO 80235
Phone (720) 713-0587

4851 Independence St
Ste 100
Wheat Ridge, CO 80033
Phone (303) 456-5495

4851 Independence St
Ste 200
Wheat Ridge, CO 80033

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1420502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1487042974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4851 INDEPENDENCE ST",
            "address_2": "SUITE 200",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336715",
            "telephone_number": "303-425-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3595 S TELLER ST",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802352014",
            "telephone_number": "303-425-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKMAN",
        "first_name": "KATHRYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-06",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "LPC.0014096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

Verify at the official NPI Registry.