Provider Demographics
NPI:1780726042
Name:GOSS, OLIVER (LCSW)
Entity type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:
Last Name:GOSS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7354
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-7354
Mailing Address - Country:US
Mailing Address - Phone:307-699-4330
Mailing Address - Fax:307-733-2837
Practice Address - Street 1:140 E. BROADWAY
Practice Address - Street 2:SUITE 25
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-699-4330
Practice Address - Fax:307-733-2837
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical