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General NPI Number Information
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NPI Number | 1417564824
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Entity Type | Individual
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Provider Name | KAITLYN ELIZABETH GOSS LUTH BCBA
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Gender | Female
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 1545 68TH ST SE STE 201
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City | KENTWOOD
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State | MI
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Zip | 49508-7896
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Country | US
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Telephone | 844-482-0532
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 S DOUGLAS RD STE 230
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City | CORAL GABLES
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State | FL
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Zip | 33134-4108
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Country | US
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Telephone | 844-244-1818
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Fax | 888-512-0733
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7401002257
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License Number State | MI
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