Provider Demographics
NPI:1033653118
Name:GOODE, HANNA
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:GOODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ARAPAHOE AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:877-539-7730
Practice Address - Street 1:2500 ARAPAHOE AVE STE 230
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6752
Practice Address - Country:US
Practice Address - Phone:877-264-6747
Practice Address - Fax:877-539-7730
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-16-21894247200000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other