Provider Demographics
NPI:1962500942
Name:GOODEN GONZALES, KATHRYN (MA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:GOODEN GONZALES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:GOODEN
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9343 TECH CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2592
Mailing Address - Country:US
Mailing Address - Phone:916-388-6400
Mailing Address - Fax:916-649-7158
Practice Address - Street 1:9343 TECH CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2592
Practice Address - Country:US
Practice Address - Phone:916-388-6400
Practice Address - Fax:916-649-7158
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist