MEDICARE: MICHAEL CHRISTOPHER GOEBEL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1548943053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CHRISTOPHER GOEBEL

Provider Business Mailing Address
First Line	:	15 S SAINT CLAIR ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-2143
Country	:	US
Telephone Number	:	937-681-0943
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 S SAINT CLAIR ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-2143
Country	:	US
Telephone Number	:	937-681-0943
Fax Number	:

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

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	08/10/2023

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