Healthcare Provider Details

I. General information

NPI: 1427963180
Provider Name (Legal Business Name): KAYLAN GOODMAN M.S., CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 WASHINGTON BLVD
OGDEN UT
84401-3744
US

IV. Provider business mailing address

1285 S 300 W
TREMONTON UT
84337-6000
US

V. Phone/Fax

Practice location:
  • Phone: 801-823-2800
  • Fax:
Mailing address:
  • Phone: 405-394-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14300866-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: