Provider Demographics
NPI:1336392638
Name:GOTHARD, KATHERINE C (PSYS, PSYD, LLP)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:C
Last Name:GOTHARD
Suffix:
Gender:F
Credentials:PSYS, PSYD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40158 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4304
Mailing Address - Country:US
Mailing Address - Phone:734-612-3409
Mailing Address - Fax:
Practice Address - Street 1:40158 WARREN RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4304
Practice Address - Country:US
Practice Address - Phone:173-461-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical