Provider Demographics
NPI:1396181418
Name:DR CAROL JEAN GOOD P.C.
Entity Type:Organization
Organization Name:DR CAROL JEAN GOOD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:303-447-8227
Mailing Address - Street 1:2975 VALMONT RD STE 310
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1361
Mailing Address - Country:US
Mailing Address - Phone:303-447-8227
Mailing Address - Fax:303-447-1427
Practice Address - Street 1:2975 VALMONT RD STE 310
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1361
Practice Address - Country:US
Practice Address - Phone:303-447-8227
Practice Address - Fax:303-447-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1983103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07019839Medicaid
CO07019839Medicaid