Provider Demographics
NPI:1932954690
Name:GOLLON, KAITELYNN JANE
Entity Type:Individual
Prefix:
First Name:KAITELYNN
Middle Name:JANE
Last Name:GOLLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 COHASSET RD STE 130
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-5403
Mailing Address - Country:US
Mailing Address - Phone:530-552-5058
Mailing Address - Fax:
Practice Address - Street 1:14172 SKYWAY
Practice Address - Street 2:STE 175
Practice Address - City:MAGALIA
Practice Address - State:CA
Practice Address - Zip Code:95954
Practice Address - Country:US
Practice Address - Phone:530-591-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor