Provider Demographics
NPI:1013171990
Name:GOOCH, WATSON PAYNE
Entity type:Individual
Prefix:MR
First Name:WATSON
Middle Name:PAYNE
Last Name:GOOCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93408-0001
Mailing Address - Country:US
Mailing Address - Phone:805-781-5300
Mailing Address - Fax:805-781-1231
Practice Address - Street 1:1276 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93408-0001
Practice Address - Country:US
Practice Address - Phone:805-781-5300
Practice Address - Fax:805-781-1231
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker