Healthcare Provider Details

I. General information

NPI: 1730525916
Provider Name (Legal Business Name): KATHY LYNN GOUWENS M.A., PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2388 SCHUETZ RD STE A10
SAINT LOUIS MO
63146-3401
US

IV. Provider business mailing address

2650 OLIVE ST
SAINT LOUIS MO
63103-1489
US

V. Phone/Fax

Practice location:
  • Phone: 314-898-0100
  • Fax: 314-993-2828
Mailing address:
  • Phone: 143-716-5003
  • Fax: 314-371-6508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20130112551
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: