Provider Demographics
NPI:1407335664
Name:GOSE, KIMBERLY (LPCC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GOSE
Suffix:
Gender:F
Credentials:LPCC
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 91
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-0091
Mailing Address - Country:US
Mailing Address - Phone:270-864-1625
Mailing Address - Fax:270-384-0610
Practice Address - Street 1:1253 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-2213
Practice Address - Country:US
Practice Address - Phone:270-864-1625
Practice Address - Fax:270-384-0610
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY299365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional