Healthcare Provider Details

I. General information

NPI: 1548943053
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER GOEBEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S SAINT CLAIR ST
DAYTON OH
45402-2143
US

IV. Provider business mailing address

15 S SAINT CLAIR ST
DAYTON OH
45402-2143
US

V. Phone/Fax

Practice location:
  • Phone: 937-681-0943
  • Fax:
Mailing address:
  • Phone: 937-681-0943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: