Healthcare Provider Details

I. General information

NPI: 1013978683
Provider Name (Legal Business Name): LYNN GOEHRING MA PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/31/2022
Certification Date: 05/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S EUCLID AVE
PIERRE SD
57501-3172
US

IV. Provider business mailing address

202 N 52ND AVE
GREELEY CO
80634-4263
US

V. Phone/Fax

Practice location:
  • Phone: 605-222-8232
  • Fax:
Mailing address:
  • Phone: 605-222-8232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number126
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number126
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number126
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: