Healthcare Provider Details

I. General information

NPI: 1013568732
Provider Name (Legal Business Name): KATIE GOOCH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 E 60 S
AMERICAN FORK UT
84003-3835
US

IV. Provider business mailing address

377 E 60 S LOWR UNIT
AMERICAN FORK UT
84003-3835
US

V. Phone/Fax

Practice location:
  • Phone: 801-901-0279
  • Fax:
Mailing address:
  • Phone: 801-500-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10113484-3902
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10113484-3902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: