Healthcare Provider Details

I. General information

NPI: 1043482425
Provider Name (Legal Business Name): KIMBERLY RENEE GOODMAN MSW, L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY FERGUSON MSW

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 N LAST CHANCE GULCH STE 211B
HELENA MT
59601-5012
US

IV. Provider business mailing address

1901 SPOKANE CREEK RD
EAST HELENA MT
59635-9786
US

V. Phone/Fax

Practice location:
  • Phone: 406-438-1324
  • Fax:
Mailing address:
  • Phone: 406-438-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number936
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: