Healthcare Provider Details

I. General information

NPI: 1669565248
Provider Name (Legal Business Name): GLENN E. GOOD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W. NIFONG BLVD. SUITE 2B
COLUMBIA MO
65203-6804
US

IV. Provider business mailing address

1612 JESSE LANE
COLUMBIA MO
65203-4721
US

V. Phone/Fax

Practice location:
  • Phone: 573-446-4929
  • Fax: 573-882-3084
Mailing address:
  • Phone: 573-446-4929
  • Fax: 573-882-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberR0271
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberR0271
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: