Provider Demographics
NPI:1265821185
Name:GOODMAN, SHELLY EVANS (LPC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:EVANS
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26105 B DR N
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-9530
Mailing Address - Country:US
Mailing Address - Phone:269-719-9260
Mailing Address - Fax:
Practice Address - Street 1:26105 B DR N
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-9530
Practice Address - Country:US
Practice Address - Phone:269-719-9260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional