Healthcare Provider Details

I. General information

NPI: 1770028979
Provider Name (Legal Business Name): BAYLEE MARIE GOODERL M.S., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 NE RICE RD BLD. A
LEES SUMMIT MO
64086-5849
US

IV. Provider business mailing address

3900 SW EVERGREEN LN
LEES SUMMIT MO
64082-4836
US

V. Phone/Fax

Practice location:
  • Phone: 816-581-5854
  • Fax:
Mailing address:
  • Phone: 816-581-5854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2015019406
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2015019406
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: