Provider Demographics
NPI:1801591136
Name:GOODSELL, TIFFANY RENEE (MED, LPC-A)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENEE
Last Name:GOODSELL
Suffix:
Gender:F
Credentials:MED, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 WINDY WALK CV
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-6931
Mailing Address - Country:US
Mailing Address - Phone:512-652-8043
Mailing Address - Fax:
Practice Address - Street 1:1816 WINDY WALK CV
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6931
Practice Address - Country:US
Practice Address - Phone:512-652-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89517101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional