Staci Lyn Gofton, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801085687 Issued in MI

Practice address

3285 122ND Ave
Allegan, MI 49010-9511

Phone

(269) 673-6617

Fax

(269) 673-2738

NPI assigned

Nov 13, 2006

Sex

Female

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

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Allegan County Community Mental Health ServicesGroup PAC ID 1153317607, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Allegan County Community Mental Health Services

  dba OnPoint

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Allegan, MI
  • NPI 1215989231
  Medicare reassignment Care Compare group NPD
• Allegan County Community Mental Health Services

  • Primary Care Clinic/Center
  • Allegan, MI
  • NPI 1528570322
  NPD
• Tahoma Enterprises LLC

  dba Tahoma Counseling

  • Social Worker
  • Jenison, MI
  • NPI 1366009961

  Clinical

  NPD (past)

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770654360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 PARKSIDE AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495343411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3285 122ND AVE",
            "city": "ALLEGAN",
            "state": "MI",
            "postal_code": "490109511",
            "telephone_number": "269-673-6617",
            "fax_number": "269-673-2738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOFTON",
        "first_name": "STACI",
        "middle_name": "LYN",
        "name_prefix": "Miss",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801085687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ezequiel G Garcia, CAADC
• Maria A. Germain-Bush
• Geniene Michelle Gersh, PHD, LPC, NCC, LLP
• Luciano Giovannucci, D.C.
• Gnegy Dental Associates
• Amanda Lee Goodman
• Emily L Gran
• David M Green, MA
• Mary Jo Griffith, RN
• Robert William Griffith, RN

• Clinical Social Worker in Allegan, MI
• Providers in Allegan, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.