Provider Demographics
NPI:1306355250
Name:GASCHK, KATHLEEN (MFTI)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GASCHK
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81557 DR CARREON BLVD STE C9
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5562
Mailing Address - Country:US
Mailing Address - Phone:760-391-6976
Mailing Address - Fax:
Practice Address - Street 1:81557 DR CARREON BLVD STE C9
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5562
Practice Address - Country:US
Practice Address - Phone:760-391-6976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF98064101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health