Provider Demographics
NPI:1740458363
Name:GOODMAN'S BEHAVIORAL HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:GOODMAN'S BEHAVIORAL HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW, LCSW
Authorized Official - Phone:608-393-7470
Mailing Address - Street 1:2213 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-9439
Mailing Address - Country:US
Mailing Address - Phone:608-768-4545
Mailing Address - Fax:608-768-4646
Practice Address - Street 1:2213 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-9439
Practice Address - Country:US
Practice Address - Phone:608-768-4545
Practice Address - Fax:608-768-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1798-123251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health