MEDICARE: TINA MARIE GOESS L.I.C.S.W.

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist
2	103TP0814X	Psychoanalysis Psychologist
3	103TB0200X	Cognitive & Behavioral Psychologist
4	101YA0400X	Addiction (Substance Use Disorder) Counselor
5	103TH0004X	Health Psychologist
6	101YM0800X	Mental Health Counselor
7	103TP2701X	Group Psychotherapy Psychologist
8	103TC2200X	Clinical Child & Adolescent Psychologist
9	1041C0700X	Clinical Social Worker	14534	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669815643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA MARIE GOESS L.I.C.S.W.

Provider Business Mailing Address
First Line	:	1424 VINCE TRL
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55121-3100
Country	:	US
Telephone Number	:	612-239-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	5874 BLACKSHIRE PATH
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1621
Country	:	US
Telephone Number	:	612-239-6262
Fax Number	:	651-774-9576

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

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	09/09/2025

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