Individual
JACOB KULP GOTWALS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
3355 N WILD DAISY PL, TUCSON, AZ 85750-3139
(505) 336-0088
Mailing address
3355 N WILD DAISY PL, TUCSON, AZ 85750-3139
(505) 336-0088
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CCMH0206221
NM
101YM0800X
Mental Health Counselor
Primary
LPC-21792
AZ
101YM0800X
Mental Health Counselor
LPC.0016856
CO
101YM0800X
Mental Health Counselor
TPMC1646
FL
101YP2500X
Professional Counselor
CCMH0206221
NM
101YP2500X
Professional Counselor
LPC.0016856
CO
Other
Enumeration date
06/27/2016
Last updated
01/28/2026
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