Provider Demographics
NPI:1205212545
Name:GOODMAN, JONATHAN CLARKE (LMHC, MHP, NCC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CLARKE
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:LMHC, MHP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 2ND ST SW
Mailing Address - Street 2:SUITE 281
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371
Mailing Address - Country:US
Mailing Address - Phone:253-234-5464
Mailing Address - Fax:
Practice Address - Street 1:1002 39TH AVE SW STE 208
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3805
Practice Address - Country:US
Practice Address - Phone:253-234-5464
Practice Address - Fax:253-317-2787
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60796049101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health