Provider Demographics
NPI:1609218536
Name:GOOD, KATHLEEN ELISE
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELISE
Last Name:GOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ELISE
Other - Last Name:DAVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11949 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3503
Mailing Address - Country:US
Mailing Address - Phone:402-595-1338
Mailing Address - Fax:402-595-1437
Practice Address - Street 1:11949 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3503
Practice Address - Country:US
Practice Address - Phone:402-595-1338
Practice Address - Fax:402-595-1437
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health