Provider Demographics
NPI:1104991199
Name:GOLDRICH, JOHN VINCENT (LMHP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:VINCENT
Last Name:GOLDRICH
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7141 S 32ND ST
Mailing Address - Street 2:315 SOUTH 9TH STREET SUITE 15
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4866
Mailing Address - Country:US
Mailing Address - Phone:402-421-3814
Mailing Address - Fax:
Practice Address - Street 1:315 S 9TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2247
Practice Address - Country:US
Practice Address - Phone:402-477-8278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1430101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE15426OtherMIDLANDS CHOICE
NE82369OtherBLUE CROSS BLUE SHIELD NE
NE15426OtherMIDLANDS CHOICE