Provider Demographics
NPI:1851907935
Name:GOFF, TAYLOR (LAC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:GOFF
Suffix:
Gender:F
Credentials:LAC
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 9541
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:479-435-4207
Mailing Address - Fax:479-935-3180
Practice Address - Street 1:324 N 2ND STREET
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-6647
Practice Address - Country:US
Practice Address - Phone:479-435-4207
Practice Address - Fax:479-935-3180
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2306006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health