Provider Demographics
NPI:1972823219
Name:GOFF, REGINA ANN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:ANN
Last Name:GOFF
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:REGINA
Other - Middle Name:ANN
Other - Last Name:KILLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2200 E SUNSHINE ST
Mailing Address - Street 2:STE 338
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1819
Mailing Address - Country:US
Mailing Address - Phone:417-823-8000
Mailing Address - Fax:417-823-9334
Practice Address - Street 1:2200 E SUNSHINE ST
Practice Address - Street 2:STE 338
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1819
Practice Address - Country:US
Practice Address - Phone:417-823-8000
Practice Address - Fax:417-823-9334
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010117191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical