Provider Demographics
NPI:1952639965
Name:GOODBAR, AIMEE (LPC)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:GOODBAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N. WAHSATCH AVE.
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903
Mailing Address - Country:US
Mailing Address - Phone:706-941-4100
Mailing Address - Fax:
Practice Address - Street 1:629 N. WEBER ST.
Practice Address - Street 2:SUITE #4
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:706-941-4100
Practice Address - Fax:719-572-6299
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO6406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health