Provider Demographics
NPI:1336372648
Name:GODDARD CONSULTING
Entity Type:Organization
Organization Name:GODDARD CONSULTING
Other - Org Name:BRIGHTER FUTURE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:C
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-586-2182
Mailing Address - Street 1:PO BOX 2413
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-2413
Mailing Address - Country:US
Mailing Address - Phone:435-586-2182
Mailing Address - Fax:866-833-5153
Practice Address - Street 1:203 E COBBLECREEK DR STE 201
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-8901
Practice Address - Country:US
Practice Address - Phone:435-586-2182
Practice Address - Fax:866-833-5153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT373214-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1821161738Medicaid
UTUT05473Medicare PIN
UT1821161738Medicaid