Healthcare Provider Details

I. General information

NPI: 1497647309
Provider Name (Legal Business Name): KATHRYN GONZALES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 CAMINO DOS RIOS STE 206
THOUSAND OAKS CA
91320-1175
US

IV. Provider business mailing address

PO BOX 10324
PALM DESERT CA
92255-0324
US

V. Phone/Fax

Practice location:
  • Phone: 805-262-8291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN GONZALES
Title or Position: CLINIC THERAPIST
Credential: MSW ASW
Phone: 760-423-8217