Provider Demographics
NPI:1245958925
Name:GOCKE, ALISHA ANN
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:ANN
Last Name:GOCKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13499 MARION ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241
Mailing Address - Country:US
Mailing Address - Phone:303-884-1326
Mailing Address - Fax:
Practice Address - Street 1:4790 TABLE MESA DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5660
Practice Address - Country:US
Practice Address - Phone:720-263-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2023-11-15
Deactivation Date:2023-10-09
Deactivation Code:
Reactivation Date:2023-10-25
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health