Provider Demographics
NPI:1902101918
Name:GOFF, DENISE LYNN (MS, LCPC, CSADC,PCGC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNN
Last Name:GOFF
Suffix:
Gender:F
Credentials:MS, LCPC, CSADC,PCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-4013
Mailing Address - Country:US
Mailing Address - Phone:309-827-2437
Mailing Address - Fax:309-827-0456
Practice Address - Street 1:313 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4013
Practice Address - Country:US
Practice Address - Phone:309-827-2437
Practice Address - Fax:309-827-0456
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006782101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional