Provider Demographics
NPI:1003223579
Name:GOUNARIS, KATHARINA (BSW, CDVP)
Entity Type:Individual
Prefix:
First Name:KATHARINA
Middle Name:
Last Name:GOUNARIS
Suffix:
Gender:F
Credentials:BSW, CDVP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3437
Mailing Address - Country:US
Mailing Address - Phone:815-344-1230
Mailing Address - Fax:
Practice Address - Street 1:101 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3437
Practice Address - Country:US
Practice Address - Phone:815-344-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILXOH848898161OtherBLUECROSS BLUESHIELD, BLUE ADVANTAGE HMO