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General NPI Number Information
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NPI Number | 1083485536
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Entity Type | Individual
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Provider Name | ALYSHA GOHEEN SWLC
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Gender | Female
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 2809 GREAT NORTHERN LOOP STE 300B
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City | MISSOULA
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State | MT
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Zip | 59808-1749
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Country | US
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Telephone | 406-233-0230
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Fax | 406-813-2356
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Provider Business Mailing Address
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Address Line | PO BOX 8102
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City | MISSOULA
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State | MT
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Zip | 59807-8102
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Country | US
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Telephone | 406-360-7512
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Fax | 406-813-2356
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | BBH-LCSW-LIC-78845
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License Number State | MT
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