Healthcare Provider Details

I. General information

NPI: 1821163411
Provider Name (Legal Business Name): ADAM M GODDARD LPC, LMFT, MAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 33100 BOX LANDSTUHL
APO AE
09180-3100
US

IV. Provider business mailing address

UNIT 33100 BOX LANDSTUHL
APO AE
09180-3100
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-6652
  • Fax:
Mailing address:
  • Phone: 315-253-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number508309
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2538
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0804
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: