Provider Demographics
NPI:1962856153
Name:GOOD, ALLISCENT
Entity Type:Individual
Prefix:
First Name:ALLISCENT
Middle Name:
Last Name:GOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 N ARDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1942
Mailing Address - Country:US
Mailing Address - Phone:225-573-6271
Mailing Address - Fax:
Practice Address - Street 1:9418 BROOKLINE AVE STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1428
Practice Address - Country:US
Practice Address - Phone:225-930-2993
Practice Address - Fax:225-930-2991
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health