Provider Demographics
NPI:1588270714
Name:GOETHEL, ANGELA SHARI (LPC-IT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SHARI
Last Name:GOETHEL
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:SHARI
Other - Last Name:BARROWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1509 CLIFFVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-7012
Mailing Address - Country:US
Mailing Address - Phone:608-799-3497
Mailing Address - Fax:
Practice Address - Street 1:115 5TH AVE S STE 523
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4018
Practice Address - Country:US
Practice Address - Phone:608-797-5679
Practice Address - Fax:608-782-4426
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4728226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional