Healthcare Provider Details

I. General information

NPI: 1669367066
Provider Name (Legal Business Name): ELIZABETH ELLEN GOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/30/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8620 W EMERALD ST STE 150
BOISE ID
83704-4839
US

IV. Provider business mailing address

5519 N BRIGADOON AVE
MERIDIAN ID
83646-1126
US

V. Phone/Fax

Practice location:
  • Phone: 208-617-3265
  • Fax:
Mailing address:
  • Phone: 208-284-6594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7371566
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: