Provider Demographics
NPI:1659445005
Name:GOSHORN, RORY DENNIS (MFT PSYD)
Entity Type:Individual
Prefix:MR
First Name:RORY
Middle Name:DENNIS
Last Name:GOSHORN
Suffix:
Gender:M
Credentials:MFT PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:#3
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7045
Mailing Address - Country:US
Mailing Address - Phone:760-219-4655
Mailing Address - Fax:760-778-3781
Practice Address - Street 1:2150 E TAHQUITZ CANYON WAY
Practice Address - Street 2:#3
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7045
Practice Address - Country:US
Practice Address - Phone:760-219-4655
Practice Address - Fax:760-778-3781
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMM00427MMedicare ID - Type Unspecified