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General NPI Number Information
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NPI Number | 1225573835
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Entity Type | Organization
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Legal Business Name | MARY GOOD LMFT 97461
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 5796 BLANK RD
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City | SEBASTOPOL
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State | CA
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Zip | 95472-6114
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Country | US
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Telephone | 415-552-6446
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 912
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City | SEBASTOPOL
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State | CA
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Zip | 95473-0912
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MARY GOOD
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Credential | LMFT
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Telephone | 415-552-6446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LMFT 97461
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License Number State | CA
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