Provider Demographics
NPI:1285009324
Name:GOODRICH, SAMANTHA LEIGH (BA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20370 POE SHOLES DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7938
Mailing Address - Country:US
Mailing Address - Phone:541-318-1377
Mailing Address - Fax:
Practice Address - Street 1:630 N ARROWLEAF TRL
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-2610
Practice Address - Country:US
Practice Address - Phone:541-549-1318
Practice Address - Fax:541-588-6002
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health