Provider Demographics
NPI:1821375445
Name:GOSS, MARY ANN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:GOSS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 YOUREE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3667
Mailing Address - Country:US
Mailing Address - Phone:318-671-4341
Mailing Address - Fax:318-220-4039
Practice Address - Street 1:2800 YOUREE DR STE 120
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3667
Practice Address - Country:US
Practice Address - Phone:318-671-4341
Practice Address - Fax:318-220-4039
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5194101YM0800X, 101YP2500X, 103TA0400X, 103TP2701X, 1041C0700X, 106H00000X
171M00000X
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist