Healthcare Provider Details

I. General information

NPI: 1649701483
Provider Name (Legal Business Name): SUSAN RAE GOOCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LINCOLN BEHAVIORAL 9315 TELEGRAPH RD, REDFORD MI
REDFORD MI
48239
US

IV. Provider business mailing address

11324 BEECH DALY, REDFORD MI 48239
REDFORD MI
48239
US

V. Phone/Fax

Practice location:
  • Phone: 313-450-4500
  • Fax: 313-450-0004
Mailing address:
  • Phone: 248-653-4316
  • Fax: 413-788-2173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704179162
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: