Provider Demographics
NPI:1659659266
Name:GOODRICH, ALLISON L
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
Last Name:GOODRICH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MONTGOMERY ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-1904
Mailing Address - Country:US
Mailing Address - Phone:619-540-1124
Mailing Address - Fax:
Practice Address - Street 1:300 MONTGOMERY ST STE 204
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-1904
Practice Address - Country:US
Practice Address - Phone:415-202-5159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1489106H00000X
VA0717002345106H00000X
CA97915106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist