Provider Demographics
NPI:1932975315
Name:GOETSCH, ROBERT CARL JR (RMHCI)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CARL
Last Name:GOETSCH
Suffix:JR
Gender:M
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SENTINEL TRL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5416
Mailing Address - Country:US
Mailing Address - Phone:386-679-6217
Mailing Address - Fax:
Practice Address - Street 1:381 PALM COAST PKWY SW UNIT 1
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4782
Practice Address - Country:US
Practice Address - Phone:386-597-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health