MEDICARE: AMY MARTHA GOOCH

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	APCC11653	CA
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700472750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MARTHA GOOCH

Provider Business Mailing Address
First Line	:	6512 VISCOUNT WAY
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-0141
Country	:	US
Telephone Number	:	916-402-0998
Fax Number	:

Provider Business Practice Location Address
First Line	:	6060 SUNRISE VISTA DR
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7053
Country	:	US
Telephone Number	:	916-967-6253
Fax Number	:

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

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	10/11/2023

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