Healthcare Provider Details

I. General information

NPI: 1770540742
Provider Name (Legal Business Name): BRIAN CRAIG GOFF PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 S MACADAM AVE SUITE 100
PORTLAND OR
97239-3620
US

IV. Provider business mailing address

1110 SE ALDER STREET STE 301 - PMB 144
PORTLAND OR
97214-2400
US

V. Phone/Fax

Practice location:
  • Phone: 503-224-0482
  • Fax: 503-462-1413
Mailing address:
  • Phone: 503-224-0482
  • Fax: 503-462-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1704
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1407
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: