Provider Demographics
NPI:1124583414
Name:GOODENOUGH, HOLLY LYNN
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:GOODENOUGH
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 1:530 KINGS COUNTY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5954
Mailing Address - Country:US
Mailing Address - Phone:559-415-6737
Mailing Address - Fax:
Practice Address - Street 1:530 KINGS COUNTY DR STE 102
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5954
Practice Address - Country:US
Practice Address - Phone:559-415-6737
Practice Address - Fax:559-442-6114
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker