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Individual

GARY GOOLSBEE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LICSW

Contact information

Practice address
121 11TH AVE SE, FOREST LAKE, MN 55025-1850
(651) 251-5220
(651) 251-5279
Mailing address
7066 STILLWATER BLVD N, OAKDALE, MN 55128-3937
(651) 777-5222
(651) 251-5111

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
00593
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1004398
P1
MN
01
105133
UC
MN
01
17581
HP
MN
01
5H799GO
BCBS
MN
01
62-15995
UBH
MN
Enumeration date
07/26/2006
Last updated
07/08/2007
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