Provider Demographics
NPI:1871184739
Name:GOEHRING, MARCIE SUSAN (LPCC)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:SUSAN
Last Name:GOEHRING
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:SUSAN
Other - Last Name:GILLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1161 BAY RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-6763
Mailing Address - Country:US
Mailing Address - Phone:612-716-4513
Mailing Address - Fax:
Practice Address - Street 1:6701 PARKWAY CIR STE 300
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2849
Practice Address - Country:US
Practice Address - Phone:612-767-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health