Basic Information
| Provider Information | |||||||||
| NPI: | 1437488293 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLETZ | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 REBECCA DR | ||||||||
| Address2: | |||||||||
| City: | BURNS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370296038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158389634 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 UFFELMAN DR STE F | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370432970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319207333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2009 | ||||||||
| LastUpdateDate: | 12/08/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.