Provider Demographics
NPI:1780959247
Name:GOODRICH, DAVID JAY (PSYD, MFT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAY
Last Name:GOODRICH
Suffix:
Gender:M
Credentials:PSYD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 GOOD HOPE DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9075
Mailing Address - Country:US
Mailing Address - Phone:714-397-1661
Mailing Address - Fax:
Practice Address - Street 1:7501 VILLAGE SQUARE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-3700
Practice Address - Country:US
Practice Address - Phone:720-633-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12347095OtherCAQH