Provider Demographics
NPI:1790174126
Name:GOSSENS, KARLA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:GOSSENS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:
Other - Last Name:KANTOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2831 WUNSCH RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:MI
Mailing Address - Zip Code:49451-9744
Mailing Address - Country:US
Mailing Address - Phone:616-840-6826
Mailing Address - Fax:
Practice Address - Street 1:2831 WUNSCH RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:MI
Practice Address - Zip Code:49451-9744
Practice Address - Country:US
Practice Address - Phone:616-840-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health