MEDICARE: DANYELL GOGGANS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C.1801376	OH

General Provider Information

NPI Number	:	1285102848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANYELL GOGGANS LPC

Provider Business Mailing Address
First Line	:	1785 E WATERFORD CT APT 528
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-8381
Country	:	US
Telephone Number	:	330-990-9645
Fax Number	:

Provider Business Practice Location Address
First Line	:	12417 CEDAR RD STE 21
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3157
Country	:	US
Telephone Number	:	330-990-9645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2018
Last Update Date	:	11/12/2018

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