Provider Demographics
NPI:1821273251
Name:GOFFIN, JAIME RAE (LCSW, CADCI)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:RAE
Last Name:GOFFIN
Suffix:
Gender:F
Credentials:LCSW, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8156
Mailing Address - Country:US
Mailing Address - Phone:208-316-7103
Mailing Address - Fax:208-549-9654
Practice Address - Street 1:493 EASTLAND DR
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7441
Practice Address - Country:US
Practice Address - Phone:208-316-7103
Practice Address - Fax:208-735-2482
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID294491041C0700X
IDLMSW-27408101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical