Provider Demographics
NPI:1093574766
Name:GOETTSCH, LISA DAWN (AMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:GOETTSCH
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARKSHORE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4726
Mailing Address - Country:US
Mailing Address - Phone:916-467-8751
Mailing Address - Fax:916-404-5622
Practice Address - Street 1:101 PARKSHORE DR STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4726
Practice Address - Country:US
Practice Address - Phone:916-467-8751
Practice Address - Fax:916-404-5622
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138965106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist