Provider Demographics
NPI:1255620548
Name:GORETSKA, MANDI (LMSW)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:GORETSKA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1679 128TH ST
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-8803
Mailing Address - Country:US
Mailing Address - Phone:641-344-7330
Mailing Address - Fax:
Practice Address - Street 1:1502 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5602
Practice Address - Country:US
Practice Address - Phone:325-672-9999
Practice Address - Fax:325-672-5237
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079646101YM0800X
1041C0700X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor