Active NPI
Lacey Gooch
- Counselor
- Fresno, CA
National Provider Identifier
1760659536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 114 E Shaw Ave
Suit 210
Fresno, CA 93710-7621 - Phone
- (559) 221-8100
- NPI assigned
- May 12, 2008
- Last updated
- May 12, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | NU | Primary |
Addresses
Primary practice location
114 E Shaw Ave
Suit 210
Fresno, CA 93710-7621
Mailing address
114 E Shaw Ave
Suit 210
Fresno, CA 93710-7621
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tackle Health LLC | Current | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210550400000",
"number": "1760659536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 E SHAW AVE",
"address_2": "SUIT 210",
"city": "FRESNO",
"state": "CA",
"postal_code": "937107621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 E SHAW AVE",
"address_2": "SUIT 210",
"city": "FRESNO",
"state": "CA",
"postal_code": "937107621",
"telephone_number": "559-221-8100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOOCH",
"first_name": "LACEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-12",
"last_updated": "2008-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.