Provider Demographics
NPI:1447751342
Name:KOSHIMIZU, CAROL GOOLSBY (MS, AMFT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:GOOLSBY
Last Name:KOSHIMIZU
Suffix:
Gender:F
Credentials:MS, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3043
Mailing Address - Country:US
Mailing Address - Phone:760-766-6265
Mailing Address - Fax:
Practice Address - Street 1:1029 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3043
Practice Address - Country:US
Practice Address - Phone:760-766-6265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF95869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health