Provider Demographics
NPI:1639908940
Name:GOODELL, SHAUNA (CRM, CADC-R)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:GOODELL
Suffix:
Gender:F
Credentials:CRM, CADC-R
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:
Other - Last Name:GOODELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRM, CADC-R
Mailing Address - Street 1:230 N 3RD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-9679
Mailing Address - Country:US
Mailing Address - Phone:541-998-5660
Mailing Address - Fax:
Practice Address - Street 1:1235 MAIN ST
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386-1609
Practice Address - Country:US
Practice Address - Phone:541-818-0379
Practice Address - Fax:541-995-5013
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1669092201101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)