Healthcare Provider Details

I. General information

NPI: 1912837642
Provider Name (Legal Business Name): TARA GOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3198 F RD STE 101
GRAND JUNCTION CO
81504-4039
US

IV. Provider business mailing address

2695 PARADISE WAY
GRAND JUNCTION CO
81506-8618
US

V. Phone/Fax

Practice location:
  • Phone: 970-640-8805
  • Fax:
Mailing address:
  • Phone: 970-640-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0024387
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: