Provider Demographics
NPI:1083485536
Name:GOHEEN, ALYSHA (SWLC)
Entity Type:Individual
Prefix:
First Name:ALYSHA
Middle Name:
Last Name:GOHEEN
Suffix:
Gender:F
Credentials:SWLC
Other - Prefix:
Other - First Name:ALYSHA
Other - Middle Name:GOHEEN
Other - Last Name:JANNOTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 8102
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-8102
Mailing Address - Country:US
Mailing Address - Phone:406-360-7512
Mailing Address - Fax:406-813-2356
Practice Address - Street 1:800 KENSINGTON AVE STE 211A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5670
Practice Address - Country:US
Practice Address - Phone:406-233-0230
Practice Address - Fax:406-813-2356
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-514991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical