Provider Demographics
NPI:1215951728
Name:GOETTLE, ROBERT DANIEL (MA LMHC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:GOETTLE
Suffix:
Gender:M
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 BROADWAY E
Mailing Address - Street 2:#20
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5787
Mailing Address - Country:US
Mailing Address - Phone:206-372-8400
Mailing Address - Fax:206-770-7211
Practice Address - Street 1:229 BROADWAY E
Practice Address - Street 2:#20
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5787
Practice Address - Country:US
Practice Address - Phone:206-372-8400
Practice Address - Fax:206-770-7211
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health