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General NPI Number Information
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NPI Number | 1588270714
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Entity Type | Individual
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Provider Name | ANGELA SHARI GOETHEL LPC-IT
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Gender | Female
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 115 5TH AVE S STE 523
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City | LA CROSSE
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State | WI
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Zip | 54601-4018
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Country | US
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Telephone | 608-797-5679
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Fax | 608-782-4426
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Provider Business Mailing Address
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Address Line | 1509 CLIFFVIEW AVE
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City | ONALASKA
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State | WI
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Zip | 54650-7012
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Country | US
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Telephone | 608-799-3497
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4728226
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License Number State | WI
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