Provider Demographics
NPI:1184045858
Name:GOUBEAU, KAITLYN (LICSW, DSW)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:GOUBEAU
Suffix:
Gender:F
Credentials:LICSW, DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 188TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8706
Mailing Address - Country:US
Mailing Address - Phone:360-218-4645
Mailing Address - Fax:360-218-4645
Practice Address - Street 1:6231 188TH ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8706
Practice Address - Country:US
Practice Address - Phone:425-346-0251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60646397104100000X, 1041C0700X
101YM0800X
WALW610555381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health