Individual
DR. ANISA N GOFORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, NCSP
Contact information
Practice address
1444 MANSFIELD AVE, MISSOULA, MT 59812-0001
(406) 493-6471
Mailing address
619 HOWELL ST, MISSOULA, MT 59802-2534
(503) 562-9379
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1482
MT
103TS0200X
School Psychologist
87674
MT
Other
Enumeration date
11/11/2014
Last updated
11/11/2014
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