Provider Demographics
NPI:1467144782
Name:PACIFIC MENTAL HEALTH ARIZONA LLC
Entity Type:Organization
Organization Name:PACIFIC MENTAL HEALTH ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MA, LMHC
Authorized Official - Phone:425-582-2041
Mailing Address - Street 1:5108 196TH ST SW STE 310
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6152
Mailing Address - Country:US
Mailing Address - Phone:425-697-3674
Mailing Address - Fax:
Practice Address - Street 1:101 N 1ST AVE STE 800
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1902
Practice Address - Country:US
Practice Address - Phone:425-582-2041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health