Provider Demographics
NPI:1477218923
Name:GOULD, KAITLYN NICOLE (LMSW)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:NICOLE
Last Name:GOULD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:DURSEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:201 W WASHINGTON AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1074
Mailing Address - Country:US
Mailing Address - Phone:616-259-5452
Mailing Address - Fax:
Practice Address - Street 1:201 W WASHINGTON AVE STE 280
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1074
Practice Address - Country:US
Practice Address - Phone:616-259-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health