Provider Demographics
NPI:1487412052
Name:IAN GOLDSBROUGH LPC, PLC
Entity type:Organization
Organization Name:IAN GOLDSBROUGH LPC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:765-714-6989
Mailing Address - Street 1:741 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1221
Mailing Address - Country:US
Mailing Address - Phone:765-714-6989
Mailing Address - Fax:
Practice Address - Street 1:741 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1221
Practice Address - Country:US
Practice Address - Phone:765-714-6989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty