Mark Christopher Goetz, PHD

Psychologist · Champlin, MN

Individual Active NPI

NPI number 1780978023

Practice location

11269 Jefferson Hwy N
Champlin, MN 55316-3123
Phone
(763) 236-0600

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NPI record

NPI
1780978023
Entity type
Individual (Type 1)
Enumeration date
June 3, 2011
Last updated
April 9, 2021
Certified
April 9, 2021
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Psychologist Primary 103T00000X — —
Rehabilitation Psychologist 103TR0400X — —
Physical Medicine & Rehabilitation Physician 208100000X PY60230406 WA
Clinical Psychologist 103TC0700X PY60230406 WA
Counseling Psychologist 103TC1900X — —
Clinical Child & Adolescent Psychologist 103TC2200X PY60230406 WA
Family Psychologist 103TF0000X — —
Health Psychologist 103TH0004X — —

Mailing address

401 14TH Ave SE
Puyallup, WA 98372
Phone
(253) 697-2700

About Dr. Goetz

Mark Christopher Goetz, PHD is a healthcare provider registered in the NPI registry with the primary taxonomy Psychologist (code 103T00000X). The practice location is 11269 Jefferson Hwy N, Champlin, MN 55316-3123. The NPI number 1780978023 was assigned on June 3, 2011 and the record was last updated on April 9, 2021.

Dr. Goetz lists 3 licenses in the registry: #PY60230406 (WA) for Physical Medicine & Rehabilitation Physician; #PY60230406 (WA) for Clinical Psychologist; #PY60230406 (WA) for Clinical Child & Adolescent Psychologist. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Mark Christopher Goetz, PHD?

The NPI number is 1780978023.

What is the phone number of Dr. Goetz?

The phone number listed for the practice location is (763) 236-0600.

Where is Dr. Goetz located?

11269 Jefferson Hwy N, Champlin, MN 55316-3123.

What is the taxonomy code for Dr. Goetz?

The primary taxonomy code is 103T00000X – Psychologist; 7 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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