| Doctor Name: | DR. HENRY J. GOETZE |
| NPI Number: | 1053335232 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 007274 |
| Business Practice Address: | 100 W. Beaver Creek Blvd Suite 218 Avon, CO - 816208572 |
| Business Phone Number: | 8455944692 |
| Business Fax Number: | 8454711815 |
| Mailing Address: | Po Box 8572, 100 W. Beaver Creek Blvd, Suite 218 AVON |
| State: | CO |
| Postal Code: | 816208572 |
| Phone Number: | 8455944692 |
| Fax Number: | 8454711815 |
| NPI Enumeration Date: | 07/27/2006 |
| NPI Last Update Date: | 11/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 007274 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |