Provider Demographics
NPI:1578960209
Name:GOTTSCHALL, BRITTANY (MA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:GOTTSCHALL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 S FORT THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2453
Mailing Address - Country:US
Mailing Address - Phone:859-442-8439
Mailing Address - Fax:859-781-0123
Practice Address - Street 1:7699 US 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1909
Practice Address - Country:US
Practice Address - Phone:859-442-8439
Practice Address - Fax:859-781-0123
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY204550492OtherTAX ID
KY610661458OtherTAX ID