Provider Demographics
NPI:1235631243
Name:GOODNOUGH, GARY (LCMHC, NCC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:GOODNOUGH
Suffix:
Gender:M
Credentials:LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 THURLOW ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-1316
Mailing Address - Country:US
Mailing Address - Phone:603-254-4058
Mailing Address - Fax:
Practice Address - Street 1:4 POST OFFICE SQ
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-1533
Practice Address - Country:US
Practice Address - Phone:603-254-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH290101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health