MEDICARE: PAOLA GOYENECHE LPC

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

General Provider Information

NPI Number	:	1528471364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAOLA GOYENECHE LPC

Provider Business Mailing Address
First Line	:	1293 PROFESSIONAL DR STE A
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5754
Country	:	US
Telephone Number	:	843-424-7705
Fax Number	:

Provider Business Practice Location Address
First Line	:	5015 CAROLINA FOREST BLVD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579
Country	:	US
Telephone Number	:	843-945-1740
Fax Number	:

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

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	05/06/2019

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