Provider Demographics
NPI:1124662044
Name:GONZALEZ, KATHREN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KATHREN
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 1ST AVE E STE 15
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4965
Mailing Address - Country:US
Mailing Address - Phone:406-709-3938
Mailing Address - Fax:
Practice Address - Street 1:307 1ST AVE E STE 15
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4965
Practice Address - Country:US
Practice Address - Phone:406-709-3938
Practice Address - Fax:406-226-0547
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT391091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical