Provider Demographics
NPI:1831413939
Name:GOODMAN, JONATHAN (MA)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16340 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5626
Mailing Address - Country:US
Mailing Address - Phone:206-349-9484
Mailing Address - Fax:
Practice Address - Street 1:1010 S 146TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98168-3669
Practice Address - Country:US
Practice Address - Phone:206-439-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health