Provider Demographics
NPI:1801991112
Name:GOOD, REBECCA M (MA, RNC, ACRN, LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:GOOD
Suffix:
Gender:F
Credentials:MA, RNC, ACRN, LPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA RNC ACRN, LPC
Mailing Address - Street 1:7730 QUICKSILVER DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5500
Mailing Address - Country:US
Mailing Address - Phone:801-942-5900
Mailing Address - Fax:925-401-1124
Practice Address - Street 1:7730 QUICKSILVER DRIVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-5500
Practice Address - Country:US
Practice Address - Phone:801-942-5900
Practice Address - Fax:925-401-1124
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT268995-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional