Provider Demographics
NPI:1730618604
Name:GOFORTH, RACHEL ANN
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANN
Last Name:GOFORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 BURNSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-0703
Mailing Address - Country:US
Mailing Address - Phone:775-772-6998
Mailing Address - Fax:
Practice Address - Street 1:305 W MOANA LN STE D-1
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4984
Practice Address - Country:US
Practice Address - Phone:775-337-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health