Provider Demographics
NPI:1962776732
Name:TARA GOETZ COUNSELING
Entity type:Organization
Organization Name:TARA GOETZ COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-535-2555
Mailing Address - Street 1:P.O. BOX 7474
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30502
Mailing Address - Country:US
Mailing Address - Phone:770-535-2555
Mailing Address - Fax:
Practice Address - Street 1:7030 BOATHOUSE WAY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542
Practice Address - Country:US
Practice Address - Phone:770-535-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-26
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005610251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health