Ozark Gore

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

Practice address

4804 Lacey Blvd SE Ste a
Lacey, WA 98503-5733

Phone

(360) 799-5782

NPI assigned

Mar 6, 2020

Last updated

Mar 6, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pathways Mental Health Services

  • Mental Health Counselor
  • Olympia, WA
  • NPI 1306004775
  NPD (past)

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

{
    "created_epoch": "1583452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583452800000",
    "number": "1750916086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6703 OAKBROOK CT SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985135672",
            "telephone_number": "808-214-4948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4804 LACEY BLVD SE STE A",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035733",
            "telephone_number": "360-799-5782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORE",
        "first_name": "OZARK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-06",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Camille Goodale, LMT
• Renae Goodell, PTA, LMP
• Amber Lynn Goodman, M.A.
• Madison Goodwin
• Mahesh Gopalaiah, RPH
• Deborah Gorman
• Steven J Gorton, MD
• Tanya Theresa Gotay
• Heather K Gozdzialski
• Tahlie Graber, OD

• Addiction (Substance Use Disorder) Psychologist in Lacey, WA
• Providers in Lacey, WA by specialty
• Addiction (Substance Use Disorder) Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.