Provider Demographics
NPI:1366614323
Name:GOLBECK, KATIE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:GOLBECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16019 E SUNFLOWER DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3677
Mailing Address - Country:US
Mailing Address - Phone:480-405-5159
Mailing Address - Fax:
Practice Address - Street 1:16019 E SUNFLOWER DR
Practice Address - Street 2:UNIT 2
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3677
Practice Address - Country:US
Practice Address - Phone:480-405-5159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0139031041C0700X
PA#CW0164451041C0700X
AZ153121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ974695Medicaid
AZZ172236Medicare PIN