Provider Demographics
NPI:1225374168
Name:GOETSCH, YVONNE
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:GOETSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:GOETSCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASE MANAGER
Mailing Address - Street 1:327 NW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5608
Mailing Address - Country:US
Mailing Address - Phone:580-536-4212
Mailing Address - Fax:
Practice Address - Street 1:327 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5608
Practice Address - Country:US
Practice Address - Phone:580-536-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health