Provider Demographics
NPI:1598159790
Name:GOSS, JAMES PAUL III (MS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PAUL
Last Name:GOSS
Suffix:III
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:GOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFTI
Mailing Address - Street 1:1005 A ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3127
Mailing Address - Country:US
Mailing Address - Phone:415-497-4572
Mailing Address - Fax:
Practice Address - Street 1:1005 A ST STE 209
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3127
Practice Address - Country:US
Practice Address - Phone:415-497-4572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF60831101YA0400X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)