Provider Demographics
NPI:1497051999
Name:GOFF, JEFFERY JAMES (MA)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:JAMES
Last Name:GOFF
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAIN ST STE 104
Mailing Address - Street 2:PACIFIC MENTAL HEALTH
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3180
Mailing Address - Country:US
Mailing Address - Phone:425-361-7987
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN ST STE 104
Practice Address - Street 2:PACIFIC MENTAL HEALTH
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3180
Practice Address - Country:US
Practice Address - Phone:206-427-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60500437101YM0800X
WACG60154547390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health