Provider Demographics
NPI:1295050839
Name:GOHEEN, GEOFFREY MICHAEL (CAS)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:MICHAEL
Last Name:GOHEEN
Suffix:
Gender:M
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W ABRIENDO AVE.
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1001
Mailing Address - Country:US
Mailing Address - Phone:719-621-1929
Mailing Address - Fax:719-621-1929
Practice Address - Street 1:375 W ABRIENDO AVE.
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1001
Practice Address - Country:US
Practice Address - Phone:719-621-1929
Practice Address - Fax:719-621-4974
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0997991101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)