Provider Demographics
NPI:1992507016
Name:GOFF, BENTON DUANE (MPH)
Entity type:Individual
Prefix:MR
First Name:BENTON
Middle Name:DUANE
Last Name:GOFF
Suffix:
Gender:
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E MOORE ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-1921
Mailing Address - Country:US
Mailing Address - Phone:224-289-7161
Mailing Address - Fax:
Practice Address - Street 1:4805 BROADWAY ST STE C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6702
Practice Address - Country:US
Practice Address - Phone:224-289-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health