Provider Demographics
NPI:1922788595
Name:GAUSHELL, KATHERINE FORSYTH (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:FORSYTH
Last Name:GAUSHELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12579 TIEMPO LN
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1109
Mailing Address - Country:US
Mailing Address - Phone:901-573-6196
Mailing Address - Fax:
Practice Address - Street 1:1 CHASE CORPORATE CENTER DR.
Practice Address - Street 2:SUITE 110
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-905-8497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6252G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker