Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 126 | SD |
N | 103T00000X | Psychologist | 126 | SD |
N | 103TC1900X | Counseling Psychologist | 126 | SD |
N | 103TS0200X | School Psychologist | 126 | SD |
NPI | 1013978683 |
---|---|
Provider Name | Lynn Goehring |
First Address | Pierre, SD 57501 |
Second Address | Pierre, SD 57501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0090152 | BCBS (01) | SD |
6550470 | (05) | SD |