Healthcare Provider Details

I. General information

NPI: 1871630129
Provider Name (Legal Business Name): CINDY GOFF, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 E 25TH ST STE 160
IDAHO FALLS ID
83404-7538
US

IV. Provider business mailing address

PO BOX 3815
IDAHO FALLS ID
83403-3815
US

V. Phone/Fax

Practice location:
  • Phone: 208-523-4820
  • Fax: 208-522-9859
Mailing address:
  • Phone: 208-525-2090
  • Fax: 208-525-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-267
License Number StateID

VIII. Authorized Official

Name: CINDY GOFF
Title or Position: OWNER
Credential: LPCP
Phone: 208-523-4820