Healthcare Provider Details

I. General information

NPI: 1538610209
Provider Name (Legal Business Name): ALYSSA GOODMAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 TURNER DR
LOUISVILLE IL
62858-1048
US

IV. Provider business mailing address

660 TURNER DR
LOUISVILLE IL
62858-1048
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 618-599-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180010544
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: