MEDICARE: SHELLY GOSCHA, LICENSED CLINICAL SOCIAL WORKER, PSYCHOTHERAPY SERVIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1215530167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELLY GOSCHA, LICENSED CLINICAL SOCIAL WORKER, PSYCHOTHERAPY SERVIC

Provider Business Mailing Address
First Line	:	5170 GOLDEN FOOTHILL PKWY
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9608
Country	:	US
Telephone Number	:	785-766-1885
Fax Number	:	916-235-5843

Provider Business Practice Location Address
First Line	:	5170 GOLDEN FOOTHILL PKWY
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9608
Country	:	US
Telephone Number	:	785-766-1885
Fax Number	:	916-235-5843

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	SHELLY SUE GOSCHA
Credential	:	LCSW
Telephone Number	:	785-766-1885

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	04/13/2026

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