Healthcare Provider Details

I. General information

NPI: 1063232742
Provider Name (Legal Business Name): MARY-KATE GOFF LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42815 GARFIELD RD STE 201
CLINTON TOWNSHIP MI
48038-1143
US

IV. Provider business mailing address

110 E MECHANIC ST
YALE MI
48097-3431
US

V. Phone/Fax

Practice location:
  • Phone: 586-333-5328
  • Fax:
Mailing address:
  • Phone: 586-481-0151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023944
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: