Provider Demographics
NPI:1497302384
Name:GOFF, CHASSIDY M (CBT)
Entity Type:Individual
Prefix:
First Name:CHASSIDY
Middle Name:M
Last Name:GOFF
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3003 ALDERBROOK CT S
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1626
Mailing Address - Country:US
Mailing Address - Phone:406-249-6412
Mailing Address - Fax:855-249-2776
Practice Address - Street 1:3003 ALDERBROOK CT S
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-1626
Practice Address - Country:US
Practice Address - Phone:406-249-6412
Practice Address - Fax:855-249-2776
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA60941882106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician