=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063232742
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY-KATE GOFF LLPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2024
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42815 GARFIELD RD STE 201
-----------------------------------------------------
City | CLINTON TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48038-1143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-333-5328
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 E MECHANIC ST
-----------------------------------------------------
City | YALE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48097-3431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-481-0151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6451023944
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------