MEDICARE: MS. KATHRYN GOODEN GONZALES MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	50239	CA

General Provider Information

NPI Number	:	1962500942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN GOODEN GONZALES MA

Provider Business Mailing Address
First Line	:	9343 TECH CENTER DR STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-2592
Country	:	US
Telephone Number	:	916-388-6400
Fax Number	:	916-649-7158

Provider Business Practice Location Address
First Line	:	9343 TECH CENTER DR STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-2592
Country	:	US
Telephone Number	:	916-388-6400
Fax Number	:	916-649-7158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	03/07/2012

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