Provider Demographics
NPI:1952577124
Name:GOETZ, DAVID A (MS LMHC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:GOETZ
Suffix:
Gender:M
Credentials:MS LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 STATE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6602
Mailing Address - Country:US
Mailing Address - Phone:425-823-7066
Mailing Address - Fax:425-468-9361
Practice Address - Street 1:608 STATE ST STE 130
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6602
Practice Address - Country:US
Practice Address - Phone:425-823-7066
Practice Address - Fax:425-468-9361
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00021752101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
WALH 60148410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00021752OtherWASHINGTON STATE REGISTERED COUNSELOR
WALH 60148410OtherLICENSED MENTAL HEALTH COUNSELOR