Doctor Name: | LUKE GOETTLICHER |
NPI Number: | 1427484898 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LADC |
License Number: | 302300 |
Business Practice Address: | 16201 90th St Ne Suite 200 Otsego, MN - 553307463 |
Business Phone Number: | 7637469492 |
Business Fax Number: | 7637463685 |
Mailing Address: | 1900 Silver Lake Rd Nw, Suite 110 NEW BRIGHTON |
State: | MN |
Postal Code: | 551121786 |
Phone Number: | 6516289566 |
Fax Number: | |
NPI Enumeration Date: | 09/17/2013 |
NPI Last Update Date: | 09/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 302300 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |