Provider Demographics
NPI:1518062496
Name:GOOD, CAROL JEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JEAN
Last Name:GOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 VALMONT RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301
Mailing Address - Country:US
Mailing Address - Phone:303-447-8227
Mailing Address - Fax:303-447-1427
Practice Address - Street 1:2975 VALMONT RD
Practice Address - Street 2:SUITE 310
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-447-8227
Practice Address - Fax:303-447-1427
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1983103TC0700X
CO146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07019839Medicaid
068Medicare ID - Type Unspecified