=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689695975
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN MORRIS GOEKE PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2006
-----------------------------------------------------
Last Update Date | 10/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 606 N ELM ST
-----------------------------------------------------
City | HIGH POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27262-4332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-889-8877
-----------------------------------------------------
Fax | 336-889-3488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 624 QUAKER LN SUITE 207 C
-----------------------------------------------------
City | HIGH POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27262-3832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-883-2500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 1813
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------