MEDICARE: BENJAMIN GOERTZ AAC

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	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	LPC-21393	AZ

General Provider Information

NPI Number	:	1396214219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN GOERTZ AAC

Provider Business Mailing Address
First Line	:	10379 E CAPERCAILLIE ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-8971
Country	:	US
Telephone Number	:	520-780-2569
Fax Number	:

Provider Business Practice Location Address
First Line	:	10379 E CAPERCAILLIE ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-8971
Country	:	US
Telephone Number	:	520-230-5626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	05/12/2025

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