Provider Demographics
NPI:1184212680
Name:GOEHLER, GRANT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:
Last Name:GOEHLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 E EAST SOLON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IL
Mailing Address - Zip Code:60071-9675
Mailing Address - Country:US
Mailing Address - Phone:330-604-7547
Mailing Address - Fax:
Practice Address - Street 1:43 E CRYSTAL LAKE AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6177
Practice Address - Country:US
Practice Address - Phone:330-604-7547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490228581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical