Provider Demographics
NPI:1427150945
Name:GOSS, KATHLEEN A (LMFT/LPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:GOSS
Suffix:
Gender:F
Credentials:LMFT/LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1461
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-1461
Mailing Address - Country:US
Mailing Address - Phone:985-285-1075
Mailing Address - Fax:601-544-5210
Practice Address - Street 1:1169 ROBERT BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2059
Practice Address - Country:US
Practice Address - Phone:985-285-1075
Practice Address - Fax:601-544-5210
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1880101YP2500X
LA224106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist