Healthcare Provider Details

I. General information

NPI: 1780730523
Provider Name (Legal Business Name): GREGORY B GOODRICH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5924 US HIGHWAY 285
MORRISON CO
80465-9101
US

IV. Provider business mailing address

9225 SANDY LN
CONIFER CO
80433-9501
US

V. Phone/Fax

Practice location:
  • Phone: 303-697-0235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number120704
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: