Provider Demographics
NPI:1619340221
Name:GOSA, WALTHENA COVINA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:WALTHENA
Middle Name:COVINA
Last Name:GOSA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10943 MAY BELLE CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5102
Mailing Address - Country:US
Mailing Address - Phone:678-438-1103
Mailing Address - Fax:
Practice Address - Street 1:10943 MAY BELLE CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-5102
Practice Address - Country:US
Practice Address - Phone:678-438-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1184106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist