Goetz Mental Wellness Initiative

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

GOETZ MENTAL WELLNESS INITIATIVE

Doing business as

Imagine Thriving

Practice address

3911 20TH Ave S
Fargo, ND 58103-4705

Phone

(701) 271-1613

NPI assigned

May 8, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Eric Monson

Title

Interim Ceo

Phone

(701) 235-7341

Specialties & licenses 1

Addresses

Other names 1

• Imagine Thriving Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588896000000",
    "number": "1316569767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3911 20TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3911 20TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034705",
            "telephone_number": "701-271-1613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOETZ MENTAL WELLNESS INITIATIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-08",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A",
        "authorized_official_last_name": "MONSON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "701-235-7341"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Imagine Thriving",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Godtime LLC
• Stacie Lynn Eileen Goeller
• Ceara N Goering, APRN,CNP
• Rachel Goerke
• Sarah Goerts
• Jennifer S Goetz, LRD
• Akshay Gogna, MD
• Nancy Gogolakis, MS, LPCC, NCC
• Joann Gohl
• Jacob A Goldenberg, MD

• Mental Health Clinic/Center (Including Community Mental Health Center) in Fargo, ND
• Providers in Fargo, ND by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.