Provider Demographics
NPI:1720579055
Name:GATELY, KARA ELIZABETH
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:ELIZABETH
Last Name:GATELY
Suffix:
Gender:F
Credentials:
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 133
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-0133
Mailing Address - Country:US
Mailing Address - Phone:530-927-7918
Mailing Address - Fax:
Practice Address - Street 1:475-750 RICE CANYON ROAD
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96127
Practice Address - Country:US
Practice Address - Phone:530-251-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 101YA0400X
CA1160471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No372600000XNursing Service Related ProvidersAdult Companion
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)