Provider Demographics
NPI:1811617822
Name:GOODENBERGER COUNSELING SOLUTIONS LLC
Entity type:Organization
Organization Name:GOODENBERGER COUNSELING SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:720-507-8287
Mailing Address - Street 1:834F S PERRY ST # 1275
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1936
Mailing Address - Country:US
Mailing Address - Phone:720-507-8287
Mailing Address - Fax:
Practice Address - Street 1:2586 GARGANEY DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7940
Practice Address - Country:US
Practice Address - Phone:720-507-8287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1831375633Medicaid