Provider Demographics
NPI:1235779554
Name:GOOD, ANDREW (LMHC, NCC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:GOOD
Suffix:
Gender:M
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7952
Mailing Address - Country:US
Mailing Address - Phone:317-804-3697
Mailing Address - Fax:
Practice Address - Street 1:121 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-7952
Practice Address - Country:US
Practice Address - Phone:317-804-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003450A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty