Healthcare Provider Details

I. General information

NPI: 1619883675
Provider Name (Legal Business Name): MELISSA GOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11589 STATE ROUTE 81
DOLA OH
45835-9706
US

IV. Provider business mailing address

129 E COURT ST
SIDNEY OH
45365-3021
US

V. Phone/Fax

Practice location:
  • Phone: 419-759-2331
  • Fax:
Mailing address:
  • Phone: 937-599-5195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: