Mariella Elle Gotz, PH.D., LPC, ATR-BC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY-202270 Issued in ID

Practice address

1010 W Hays St
Boise, ID 83702-5435

Phone

(208) 284-5273

NPI assigned

Mar 16, 2007

Last updated

May 2, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2023 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682985600000",
    "number": "1326172644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 W HAYS ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025435",
            "telephone_number": "208-284-5273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 W HAYS ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025435",
            "telephone_number": "208-284-5273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTZ",
        "first_name": "MARIELLA",
        "middle_name": "ELLE",
        "name_prefix": "Mrs.",
        "credential": "PH.D., LPC, ATR-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-16",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "LPC-3004",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ID",
            "license": "PSY-202270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326172644",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Taylor Gorton, RDN
• Matthew Thomas Gosline, LCSW
• Gott Chiropractic Inc.
• Abigail Gotto, LPC, ACMHC
• Jennifer G. Gotto, M.D.
• Sheryl Kay Goudy, LISW-S
• David Thomas Gough, D.O.
• Elizabeth Kay Gough, LMSW
• Kenneth Alan Gough, DC
• Christopher J Goulet, M.D.

• Psychologist in Boise, ID
• Providers in Boise, ID by specialty
• Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.