Provider Demographics
NPI:1457502700
Name:GOODMAN, NANCY (LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
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 1:845 W CENTER ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-4205
Mailing Address - Country:US
Mailing Address - Phone:208-478-1414
Mailing Address - Fax:
Practice Address - Street 1:845 W CENTER ST
Practice Address - Street 2:SUITE 306
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-4205
Practice Address - Country:US
Practice Address - Phone:208-478-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional