Provider Demographics
NPI:1306363411
Name:GOODSON, ANGELA M (TLMFT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:GOODSON
Suffix:
Gender:F
Credentials:TLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-2818
Mailing Address - Country:US
Mailing Address - Phone:620-719-8229
Mailing Address - Fax:620-229-8124
Practice Address - Street 1:222 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2818
Practice Address - Country:US
Practice Address - Phone:620-719-8229
Practice Address - Fax:620-229-8124
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist