Provider Demographics
NPI:1679638738
Name:GOBLE, SALLY RAE (LMFT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:RAE
Last Name:GOBLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-0235
Mailing Address - Country:US
Mailing Address - Phone:505-660-0846
Mailing Address - Fax:505-404-8062
Practice Address - Street 1:28 PASEO DE SAN ANTONIO
Practice Address - Street 2:
Practice Address - City:PLACITAS
Practice Address - State:NM
Practice Address - Zip Code:87043-8735
Practice Address - Country:US
Practice Address - Phone:505-660-0846
Practice Address - Fax:505-404-8062
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK203106H00000X
NM0107651106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist