Basic Information
| Provider Information | |||||||||
| NPI: | 1962500942 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOODEN GONZALES | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GONZALES | ||||||||
| OtherFirstName: | KATHRYN | ||||||||
| OtherMiddleName: | GOODEN | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9343 TECH CENTER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958262592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163886400 | ||||||||
| FaxNumber: | 9166497158 | ||||||||
| Practice Location | |||||||||
| Address1: | 9343 TECH CENTER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958262592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163886400 | ||||||||
| FaxNumber: | 9166497158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 03/07/2012 | ||||||||
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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 | 106H00000X | 50239 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.