Provider Demographics
NPI:1316958515
Name:GOETZ, JEANETTE LOUISE (LPC LADC)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:LOUISE
Last Name:GOETZ
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 1:7941 E 57TH ST
Mailing Address - Street 2:#7
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145
Mailing Address - Country:US
Mailing Address - Phone:918-671-6504
Mailing Address - Fax:918-664-1117
Practice Address - Street 1:7941 E 57TH ST
Practice Address - Street 2:#7
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145
Practice Address - Country:US
Practice Address - Phone:918-671-6504
Practice Address - Fax:918-664-1117
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42101YA0400X
OK1902103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist