Healthcare Provider Details

I. General information

NPI: 1235913518
Provider Name (Legal Business Name): GOOD COMPANY COUNSELING AND COACHING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N WILLIAMSBURG DR STE A&B
BLOOMINGTON IL
61704-7706
US

IV. Provider business mailing address

205 N WILLIAMSBURG DR STE A&B
BLOOMINGTON IL
61704-7706
US

V. Phone/Fax

Practice location:
  • Phone: 217-430-6020
  • Fax:
Mailing address:
  • Phone: 217-430-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN K COMPANY
Title or Position: OWNER
Credential: LCPC
Phone: 217-430-6020