Provider Demographics
NPI:1093488355
Name:GOOD LIFE THERAPY, LLC
Entity Type:Organization
Organization Name:GOOD LIFE THERAPY, LLC
Other - Org Name:GOOD LIFE THERAPY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUIDEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, NCC
Authorized Official - Phone:515-314-9886
Mailing Address - Street 1:5000 WESTOWN PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5936
Mailing Address - Country:US
Mailing Address - Phone:515-314-9886
Mailing Address - Fax:
Practice Address - Street 1:5000 WESTOWN PKWY STE 104
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5936
Practice Address - Country:US
Practice Address - Phone:515-314-9886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-31
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty