Provider Demographics
NPI:1730525916
Name:GOUWENS, KATHY LYNN (MA, PLPC)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:LYNN
Last Name:GOUWENS
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1489
Mailing Address - Country:US
Mailing Address - Phone:143-716-5003
Mailing Address - Fax:314-371-6508
Practice Address - Street 1:2388 SCHUETZ RD STE A10
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3401
Practice Address - Country:US
Practice Address - Phone:314-898-0100
Practice Address - Fax:314-993-2828
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130112551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional