Provider Demographics
NPI:1073761623
Name:GOFFENA, MISTY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:
Last Name:GOFFENA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S WALNUT ST
Mailing Address - Street 2:STE. 215
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2991
Mailing Address - Country:US
Mailing Address - Phone:812-523-0386
Mailing Address - Fax:
Practice Address - Street 1:415 S WALNUT ST
Practice Address - Street 2:STE. 215
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2991
Practice Address - Country:US
Practice Address - Phone:812-523-0386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional