Provider Demographics
NPI:1992383871
Name:GOACHER, APRIL
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:GOACHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13576 BRAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-6064
Mailing Address - Country:US
Mailing Address - Phone:228-547-6370
Mailing Address - Fax:
Practice Address - Street 1:9230A OLD LORRAINE RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-6059
Practice Address - Country:US
Practice Address - Phone:228-731-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSRBT-21-161913106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician