Provider Demographics
NPI:1184827750
Name:GOETTEL, SHARON R (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:GOETTEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:R
Other - Last Name:GOETTEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 43160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3160
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:1835 S CEYLON PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-7602
Practice Address - Country:US
Practice Address - Phone:520-603-8906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE408101YA0400X
AZLCSW-107711041C0700X
DEQ1-00003741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)