Provider Demographics
NPI:1063719730
Name:GOSS, ERIN (LPC, LADC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:GOSS
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 STATE ST STE 401
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6626
Mailing Address - Country:US
Mailing Address - Phone:918-683-8827
Mailing Address - Fax:918-686-0902
Practice Address - Street 1:215 STATE ST STE 401
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6626
Practice Address - Country:US
Practice Address - Phone:908-683-8827
Practice Address - Fax:918-686-0902
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1048101YA0400X
OK4980101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200527080AMedicaid