Basic Information
| Provider Information | |||||||||
| NPI: | 1881728285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOETZ | ||||||||
| FirstName: | TRISHA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | LCSW, CACIII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3701 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801133611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033606276 | ||||||||
| FaxNumber: | 3034675355 | ||||||||
| Practice Location | |||||||||
| Address1: | 3292 PEORIA ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800101517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033436130 | ||||||||
| FaxNumber: | 3033440664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 07/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW.00992613 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | ACC.0006038 | CO | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 65306058 | 05 | CO | MEDICAID |