Provider Demographics
NPI:1841299120
Name:GOYETTE, ANDREA M (LPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:GOYETTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N GARTH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4103
Mailing Address - Country:US
Mailing Address - Phone:573-443-2204
Mailing Address - Fax:573-875-5851
Practice Address - Street 1:301 N GARTH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4107
Practice Address - Country:US
Practice Address - Phone:573-449-3953
Practice Address - Fax:573-874-3189
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002259101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1649269622OtherBILLING NPI
MO179873OtherBCBS