Provider Demographics
NPI:1508532466
Name:GOOSE, AZALEAH FRANCIS (APCC)
Entity Type:Individual
Prefix:
First Name:AZALEAH
Middle Name:FRANCIS
Last Name:GOOSE
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:FRANCES
Other - Last Name:GOOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8945 GOLF LINKS RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4124
Mailing Address - Country:US
Mailing Address - Phone:510-317-1444
Mailing Address - Fax:
Practice Address - Street 1:2465 DOLAN WAY
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-1668
Practice Address - Country:US
Practice Address - Phone:510-421-4821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC11952101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional