Provider Demographics
NPI:1710330899
Name:GOOTEE, MARIA (MSFMT, PSYD, HSPP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GOOTEE
Suffix:
Gender:F
Credentials:MSFMT, PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 WASHINGTON BLVD
Mailing Address - Street 2:#164
Mailing Address - City:NORTH OGDEN
Mailing Address - State:TX
Mailing Address - Zip Code:84414-2240
Mailing Address - Country:US
Mailing Address - Phone:214-970-6817
Mailing Address - Fax:
Practice Address - Street 1:7970 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:317-696-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042969A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical