Provider Demographics
NPI:1740974229
Name:GOODE, MINNIE LYNN (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:MINNIE
Middle Name:LYNN
Last Name:GOODE
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 LANKERSHIM BLVD STE F242
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4538
Mailing Address - Country:US
Mailing Address - Phone:323-455-4775
Mailing Address - Fax:
Practice Address - Street 1:44 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4339
Practice Address - Country:US
Practice Address - Phone:323-860-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139743106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist