MEDICARE: DR. KATHERINE C GOTHARD PSY.S., PSY.D., LLP

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	103TC0700X	Clinical Psychologist	6301013405	MI

General Provider Information

NPI Number	:	1336392638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE C GOTHARD PSY.S., PSY.D., LLP

Provider Business Mailing Address
First Line	:	40158 WARREN RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-4304
Country	:	US
Telephone Number	:	734-612-3409
Fax Number	:

Provider Business Practice Location Address
First Line	:	40158 WARREN RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-4304
Country	:	US
Telephone Number	:	173-461-2340
Fax Number	:

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

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	02/23/2024

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