Provider Demographics
NPI:1568746469
Name:GOKE, DOUGLAS HERMAN (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:HERMAN
Last Name:GOKE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WELLINGTON CRES
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-6731
Mailing Address - Country:US
Mailing Address - Phone:507-333-5708
Mailing Address - Fax:
Practice Address - Street 1:1500 WELLINGTON CRES
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-6731
Practice Address - Country:US
Practice Address - Phone:507-333-5708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical