Basic Information
| Provider Information | |||||||||
| NPI: | 1306122528 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOERING | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LSCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 N LORRAINE ST | ||||||||
| Address2: | STE 202 | ||||||||
| City: | HUTCHINSON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675015670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206637595 | ||||||||
| FaxNumber: | 6206635263 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 N LORRAINE ST | ||||||||
| Address2: | STE 202 | ||||||||
| City: | HUTCHINSON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675015670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206637595 | ||||||||
| FaxNumber: | 6206635263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2011 | ||||||||
| LastUpdateDate: | 10/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 8265 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.