Provider Demographics
NPI:1861706301
Name:GOETSCH, JOHN DAVID (MS - COUNSELING)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:GOETSCH
Suffix:
Gender:M
Credentials:MS - COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 NW 109TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4171
Mailing Address - Country:US
Mailing Address - Phone:360-909-3614
Mailing Address - Fax:
Practice Address - Street 1:801 NW 109TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4171
Practice Address - Country:US
Practice Address - Phone:360-909-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60161622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health