Provider Demographics
NPI:1528311479
Name:GOTTSHALL, JANET ANN
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:ANN
Last Name:GOTTSHALL
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 1:2134 S CATARINA
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6402
Mailing Address - Country:US
Mailing Address - Phone:602-571-1665
Mailing Address - Fax:480-659-7230
Practice Address - Street 1:6625 S RURAL RD STE 111
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3717
Practice Address - Country:US
Practice Address - Phone:602-571-1665
Practice Address - Fax:480-345-2126
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC13905101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional