Provider Demographics
NPI:1124193909
Name:GOODE, JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:GOODE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N MALL DR
Mailing Address - Street 2:SUITE I-102
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7302
Mailing Address - Country:US
Mailing Address - Phone:435-632-1226
Mailing Address - Fax:435-674-9380
Practice Address - Street 1:321 N MALL DR
Practice Address - Street 2:SUITE I-102
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7302
Practice Address - Country:US
Practice Address - Phone:435-632-1226
Practice Address - Fax:435-674-9380
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT124234-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical