Provider Demographics
NPI:1033592530
Name:GOAT PATH COUNSELING
Entity Type:Organization
Organization Name:GOAT PATH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ-MARCH
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-414-8144
Mailing Address - Street 1:663 W 100 S
Mailing Address - Street 2:SUITE B7
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-1002
Mailing Address - Country:US
Mailing Address - Phone:801-416-3123
Mailing Address - Fax:
Practice Address - Street 1:663 W 100 S
Practice Address - Street 2:SUITE B7
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-1002
Practice Address - Country:US
Practice Address - Phone:801-416-3123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49173766004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty