MEDICARE: KAREN KAY GOTTO LMHC,LMSW

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	101YM0800X	Mental Health Counselor	00289	IA
2	104100000X	Social Worker	02755	IA

General Provider Information

NPI Number	:	1881651263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN KAY GOTTO LMHC,LMSW

Provider Business Mailing Address
First Line	:	921 AMY CIR
Second Line	:
City	:	CARROLL
State	:	IA
Zip	:	51401-2630
Country	:	US
Telephone Number	:	712-260-2700
Fax Number	:	712-276-4917

Provider Business Practice Location Address
First Line	:	409 KENYON RD
Second Line	:	SUITE C
City	:	FORT DODGE
State	:	IA
Zip	:	50501-5718
Country	:	US
Telephone Number	:	515-573-3138
Fax Number	:	515-573-3130

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	06/10/2014

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