Provider Demographics
NPI:1932470564
Name:GOODYKOONTZ, SUSAN (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GOODYKOONTZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 S MCCLINTOCK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2692
Mailing Address - Country:US
Mailing Address - Phone:480-804-0326
Mailing Address - Fax:480-302-7884
Practice Address - Street 1:2120 S MCCLINTOCK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2692
Practice Address - Country:US
Practice Address - Phone:480-804-0326
Practice Address - Fax:480-302-7884
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-12640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health