Provider Demographics
NPI:1053760884
Name:GOFF, SAMPSON (LMFT)
Entity type:Individual
Prefix:MR
First Name:SAMPSON
Middle Name:
Last Name:GOFF
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 LANSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1718
Mailing Address - Country:US
Mailing Address - Phone:415-548-0004
Mailing Address - Fax:
Practice Address - Street 1:315 SANCHEZ ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1615
Practice Address - Country:US
Practice Address - Phone:415-820-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist