Provider Demographics
NPI:1659888410
Name:GOETHEL, JAMES WALTER (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WALTER
Last Name:GOETHEL
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:JIM GOETHEL
Other - Middle Name:
Other - Last Name:GOETHEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:4862 54TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2223
Mailing Address - Country:US
Mailing Address - Phone:619-892-5207
Mailing Address - Fax:
Practice Address - Street 1:2535 CAMINO DEL RIO S STE 106
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3764
Practice Address - Country:US
Practice Address - Phone:619-330-6003
Practice Address - Fax:619-564-6666
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist