MEDICARE: MS. DEVONAY OLSON-GOODMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPCC1010	CA
2	225C00000X	Rehabilitation Counselor	115469	CA
3	171R00000X	Interpreter	22269	CA

General Provider Information

NPI Number	:	1588395206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEVONAY OLSON-GOODMAN

Provider Business Mailing Address
First Line	:	PO BOX 908
Second Line	:
City	:	NEW HARMONY
State	:	UT
Zip	:	84757-0908
Country	:	US
Telephone Number	:	760-274-3166
Fax Number	:

Provider Business Practice Location Address
First Line	:	3085 N BROADWAY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-8808
Country	:	US
Telephone Number	:	760-274-3166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	12/02/2025

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