Provider Demographics
NPI:1700599404
Name:GOODALE, REILLY (TLMHC)
Entity Type:Individual
Prefix:
First Name:REILLY
Middle Name:
Last Name:GOODALE
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-4307
Mailing Address - Country:US
Mailing Address - Phone:515-865-0073
Mailing Address - Fax:
Practice Address - Street 1:6900 UNIVERSITY AVE STE 135
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1505
Practice Address - Country:US
Practice Address - Phone:515-218-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA116553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health