Provider Demographics
NPI:1164702296
Name:GOODHEAD, MELINDA JO (BS)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:JO
Last Name:GOODHEAD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19815 50TH AVE W APT G8
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6455
Mailing Address - Country:US
Mailing Address - Phone:425-244-1645
Mailing Address - Fax:
Practice Address - Street 1:10015 LAKE CITY WAY NE
Practice Address - Street 2:441
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7770
Practice Address - Country:US
Practice Address - Phone:425-244-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-21
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60498380101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACL 60498380OtherWA STATE DEPT. OF HEALTH COUNSELOR CERTIFIED CERTIFICATION