Healthcare Provider Details

I. General information

NPI: 1740016005
Provider Name (Legal Business Name): KALEEN GOODRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 S CEDAR ST
LANSING MI
48910-5474
US

IV. Provider business mailing address

6281 ISLAND LAKE DR
EAST LANSING MI
48823-9734
US

V. Phone/Fax

Practice location:
  • Phone: 720-656-8128
  • Fax:
Mailing address:
  • Phone: 720-656-8128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: