Provider Demographics
NPI:1205086246
Name:GOODE COUNSELING SERVICES
Entity type:Organization
Organization Name:GOODE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:OWENS
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCSW, LMFT
Authorized Official - Phone:574-231-1480
Mailing Address - Street 1:4560 S IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-9595
Mailing Address - Country:US
Mailing Address - Phone:574-231-1480
Mailing Address - Fax:
Practice Address - Street 1:4560 S IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-9595
Practice Address - Country:US
Practice Address - Phone:574-231-1480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000769A101YM0800X
IN34002903A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty