Provider Demographics
NPI:1013978683
Name:GOEHRING, LYNN (MA PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:GOEHRING
Suffix:
Gender:M
Credentials:MA PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4263
Mailing Address - Country:US
Mailing Address - Phone:605-222-8232
Mailing Address - Fax:
Practice Address - Street 1:105 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3172
Practice Address - Country:US
Practice Address - Phone:605-222-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD126103TC1900X, 103TS0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6550470Medicaid
SD0090152OtherBCBS