Provider Demographics
NPI:1700042538
Name:GOSHORN, ELLEN MARIE (ARMS-II)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:GOSHORN
Suffix:
Gender:F
Credentials:ARMS-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1062
Mailing Address - Country:US
Mailing Address - Phone:810-648-4098
Mailing Address - Fax:
Practice Address - Street 1:171 DAWSON ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1062
Practice Address - Country:US
Practice Address - Phone:810-648-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)