Active NPI
Anisa N Goforth, PHD, NCSP
- Psychologist
- Missoula, MT
National Provider Identifier
1730585217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1482
- Practice address
- 1444 Mansfield Ave
Missoula, MT 59812-0001 - Phone
- (406) 493-6471
- NPI assigned
- Nov 11, 2014
- Last updated
- Nov 11, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1482 | MT | Primary |
| School Psychologist | 103TS0200X | 87674 | MT |
Addresses
Primary practice location
1444 Mansfield Ave
Missoula, MT 59812-0001
Mailing address
619 Howell St
Missoula, MT 59802-2534
Phone (503) 562-9379
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1482 | MT | MD | Mental Health Counselor |
| 87674 | MT | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415664000000",
"number": "1730585217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "619 HOWELL ST",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598022534",
"telephone_number": "503-562-9379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1444 MANSFIELD AVE",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598120001",
"telephone_number": "406-493-6471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOFORTH",
"first_name": "ANISA",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "PHD, NCSP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-11-11",
"last_updated": "2014-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MT",
"license": "1482",
"primary": true
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "MT",
"license": "87674",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.