Individual
CA LITRA LYNNETTE GOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2420 W ECHO LN, PHOENIX, AZ 85021-4856
(602) 877-6686
Mailing address
6109 N 12TH ST UNIT 8, PHOENIX, AZ 85014-1716
(602) 877-6686
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
AZ
Other
Enumeration date
06/17/2020
Last updated
06/17/2020
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