Provider Demographics
NPI:1558887505
Name:GOSS, CHRISTINE F (LMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:F
Last Name:GOSS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 INDEPENDENCE DR # 8022
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46808-4418
Mailing Address - Country:US
Mailing Address - Phone:260-255-5270
Mailing Address - Fax:
Practice Address - Street 1:2525 INDEPENDENCE DR #8022
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-9998
Practice Address - Country:US
Practice Address - Phone:260-255-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003626A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health