1659888410 NPI number — MR. JAMES WALTER GOETHEL M.A., LMFT

Table of content: MR. JAMES WALTER GOETHEL M.A., LMFT (NPI 1659888410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659888410 NPI number — MR. JAMES WALTER GOETHEL M.A., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOETHEL
Provider First Name:
JAMES
Provider Middle Name:
WALTER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOETHEL
Provider Other First Name:
JIM GOETHEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., LMFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1659888410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4862 54TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92115-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-892-5207
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2535 CAMINO DEL RIO S STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-330-6003
Provider Business Practice Location Address Fax Number:
619-564-6666
Provider Enumeration Date:
01/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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