Provider Demographics
NPI:1578095170
Name:GOOD LAND COUNSELING, LLC
Entity Type:Organization
Organization Name:GOOD LAND COUNSELING, LLC
Other - Org Name:GOOD LAND COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TROTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-993-8708
Mailing Address - Street 1:1841 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1933
Mailing Address - Country:US
Mailing Address - Phone:773-993-8708
Mailing Address - Fax:
Practice Address - Street 1:1841 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1933
Practice Address - Country:US
Practice Address - Phone:773-993-8708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI84471231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty