Provider Demographics
NPI:1104038835
Name:GOODFELLOW, TRESA WILBEE (LMFT)
Entity Type:Individual
Prefix:
First Name:TRESA
Middle Name:WILBEE
Last Name:GOODFELLOW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TRESA
Other - Middle Name:WILBEE
Other - Last Name:WIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 14903
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082-2903
Mailing Address - Country:US
Mailing Address - Phone:360-733-4357
Mailing Address - Fax:
Practice Address - Street 1:15606 COUNTRY CLUB DR UNIT B
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1202
Practice Address - Country:US
Practice Address - Phone:360-733-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
WALF00001307106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist