Provider Demographics
NPI:1578741674
Name:GOEDEGEBUURE, ERIN LEA (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:LEA
Last Name:GOEDEGEBUURE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:FREEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17827-0373
Mailing Address - Country:US
Mailing Address - Phone:570-765-1051
Mailing Address - Fax:
Practice Address - Street 1:1372 N SUSQUEHANNA TRL
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-8971
Practice Address - Country:US
Practice Address - Phone:570-743-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health