Provider Demographics
NPI:1134247091
Name:GOEHLER, CONNIE L (PCC)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:L
Last Name:GOEHLER
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4792 MUNSON ST NW
Mailing Address - Street 2:MUNSON PROFESSIONAL CENTRE
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3630
Mailing Address - Country:US
Mailing Address - Phone:330-494-4636
Mailing Address - Fax:330-494-5861
Practice Address - Street 1:4792 MUNSON ST NW
Practice Address - Street 2:MUNSON PROFESSIONAL CENTRE
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3630
Practice Address - Country:US
Practice Address - Phone:330-494-4636
Practice Address - Fax:330-494-5861
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3756101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional