Provider Demographics
NPI:1730932245
Name:GOELZ, TIMOTHY KYLE
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:KYLE
Last Name:GOELZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 OAK PLZ
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5622
Mailing Address - Country:US
Mailing Address - Phone:832-312-1392
Mailing Address - Fax:
Practice Address - Street 1:3301 NORTHLAND DR STE 320
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4952
Practice Address - Country:US
Practice Address - Phone:833-313-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health