| Shelly Goscha, Licensed Clinical Social Worker, Psychotherapy Services | |
|
5170 Golden Foothill Pkwy El Dorado Hills CA 95762-9608 | |
| (785) 766-1885 | |
| (916) 235-5843 |
| Full Name | Shelly Goscha, Licensed Clinical Social Worker, Psychotherapy Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 5170 Golden Foothill Pkwy, El Dorado Hills, California |
| Authorized Official Name and Position | Shelly Sue Goscha (OWNER/PRESIDENT) |
| Authorized Official Contact | 7857661885 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shelly Goscha, Licensed Clinical Social Worker, Psychotherapy Services 5170 Golden Foothill Pkwy El Dorado Hills CA 95762-9608 Ph: (785) 766-1885 | Shelly Goscha, Licensed Clinical Social Worker, Psychotherapy Services 5170 Golden Foothill Pkwy El Dorado Hills CA 95762-9608 Ph: (785) 766-1885 |
| NPI Number | 1215530167 |
|---|---|
| Provider Enumeration Date | 11/20/2020 |
| Last Update Date | 02/23/2021 |
| Certification Date | 02/23/2021 |
| Medicare PECOS PAC ID | 4183039266 |
|---|---|
| Medicare Enrollment ID | O20210223002374 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215530167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Shelly Sue Goscha |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750711719 PECOS PAC ID: 8820219108 Enrollment ID: I20180124000828 |
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