Provider Demographics
NPI:1518415561
Name:GOGGINS, SHANA LEIGH (MA, LPCA)
Entity Type:Individual
Prefix:MS
First Name:SHANA
Middle Name:LEIGH
Last Name:GOGGINS
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 GOLDSMITH LN
Mailing Address - Street 2:SUITE 143
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2006
Mailing Address - Country:US
Mailing Address - Phone:502-252-1865
Mailing Address - Fax:
Practice Address - Street 1:944 RED HOUSE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-9392
Practice Address - Country:US
Practice Address - Phone:502-252-1865
Practice Address - Fax:502-631-9660
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health