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General NPI Number Information
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NPI Number | 1205086246
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Entity Type | Organization
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Legal Business Name | GOODE COUNSELING SERVICES
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 4560 S IRONWOOD DR
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City | SOUTH BEND
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State | IN
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Zip | 46614-9595
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Country | US
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Telephone | 574-231-1480
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Fax |
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Provider Business Mailing Address
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Address Line | 4560 S IRONWOOD DR
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City | SOUTH BEND
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State | IN
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Zip | 46614-9595
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Country | US
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Telephone | 574-231-1480
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TIMOTHY OWENS GOODE
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Credential | M.A., LCSW, LMFT
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Telephone | 574-231-1480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 35000769A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 34002903A
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License Number State | IN
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