Active NPI
Wava E Goetz, M.S.
- Mental Health Counselor
- Great Falls, MT
National Provider Identifier
1043369978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 490 LCPC
- Practice address
- 410 Central Ave
Suite 509
Great Falls, MT 59401-3154 - Phone
- (406) 761-7079
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 490 LCPC | MT | Primary |
Addresses
Primary practice location
410 Central Ave
Suite 509
Great Falls, MT 59401-3154
Mailing address
PO Box 1077
Great Falls, MT 59403-1077
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 253422 | Medicaid | MT | |
| 75283 | Other | MT | BLUE CROSS BLUE SHIELD MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 490 LCPC | MT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043369978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1077",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594031077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 CENTRAL AVE",
"address_2": "SUITE 509",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594013154",
"telephone_number": "406-761-7079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOETZ",
"first_name": "WAVA",
"middle_name": "E",
"credential": "M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MT",
"license": "490 LCPC",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "253422",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD MT",
"identifier": "75283",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.