MEDICARE: CHRISTINE F GOSS LMHC

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	101YM0800X	Mental Health Counselor	39003626A	IN

General Provider Information

NPI Number	:	1558887505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE F GOSS LMHC

Provider Business Mailing Address
First Line	:	2525 INDEPENDENCE DR # 8022
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-4418
Country	:	US
Telephone Number	:	260-255-5270
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 INDEPENDENCE DR #8022
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-9998
Country	:	US
Telephone Number	:	260-255-5270
Fax Number	:

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

Provider Enumeration Date	:	08/21/2017
Last Update Date	:	07/21/2022

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