Provider Demographics
NPI:1063741577
Name:GOOLEY, PATRICK JOSEPH (LCSWE)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:GOOLEY
Suffix:
Gender:M
Credentials:LCSWE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 WEBSTER CIR
Mailing Address - Street 2:
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-9792
Mailing Address - Country:US
Mailing Address - Phone:801-918-0697
Mailing Address - Fax:801-313-9669
Practice Address - Street 1:1099 WEBSTER CIR
Practice Address - Street 2:
Practice Address - City:KAMAS
Practice Address - State:UT
Practice Address - Zip Code:84036-9792
Practice Address - Country:US
Practice Address - Phone:801-918-0697
Practice Address - Fax:801-313-9669
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7453749-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical