Provider Demographics
NPI:1821163411
Name:GODDARD, ADAM M (LPC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:M
Last Name:GODDARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4512
Mailing Address - Country:US
Mailing Address - Phone:541-752-2225
Mailing Address - Fax:541-752-9086
Practice Address - Street 1:1515 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4512
Practice Address - Country:US
Practice Address - Phone:541-752-2225
Practice Address - Fax:541-752-9086
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0606034101Y00000X
ORC2538101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor