Healthcare Provider Details

I. General information

NPI: 1912886763
Provider Name (Legal Business Name): KATHERINE GOTIS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 CERRO GORDO RD
SANTA FE NM
87501-6263
US

IV. Provider business mailing address

1538 CERRO GORDO RD
SANTA FE NM
87501-6263
US

V. Phone/Fax

Practice location:
  • Phone: 505-316-8474
  • Fax:
Mailing address:
  • Phone: 505-316-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2025-0585
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: