MEDICARE: MRS. KATHRYN NOEL GOMES MA, LPC, NCC, LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0964	CO
2	101YP2500X	Professional Counselor	6036	CO

General Provider Information

NPI Number	:	1447897384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN NOEL GOMES MA, LPC, NCC, LAC

Provider Business Mailing Address
First Line	:	885 E TUFTS AVE
Second Line	:
City	:	CHERRY HILLS VILLAGE
State	:	CO
Zip	:	80113-5928
Country	:	US
Telephone Number	:	303-788-7350
Fax Number	:	303-762-0476

Provider Business Practice Location Address
First Line	:	885 E TUFTS AVE
Second Line	:
City	:	CHERRY HILLS VILLAGE
State	:	CO
Zip	:	80113-5928
Country	:	US
Telephone Number	:	303-788-7350
Fax Number	:	303-762-0476

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

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	12/10/2019

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