Individual
MARK CHRISTOPHER GOETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
11269 JEFFERSON HWY N, CHAMPLIN, MN 55316-3123
(763) 236-0600
Mailing address
401 14TH AVE SE, PUYALLUP, WA 98372
(253) 697-2700
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
PY60230406
WA
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
PY60230406
WA
103TF0000X
Family Psychologist
—
—
103TH0004X
Health Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
—
—
208100000X
Physical Medicine & Rehabilitation Physician
PY60230406
WA
Other
Enumeration date
06/03/2011
Last updated
04/09/2021
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