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General NPI Number Information
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NPI Number | 1295872794
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Entity Type | Individual
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Provider Name | EVELYN ESTHER GOODELL L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2435 E SOUTHERN AVE #2
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City | TEMPE
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State | AZ
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Zip | 85282-7628
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Country | US
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Telephone | 480-209-8118
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Fax | 480-813-4833
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Provider Business Mailing Address
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Address Line | 317 E VAUGHN AVE
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City | GILBERT
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State | AZ
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Zip | 85234-9301
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Country | US
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Telephone | 480-813-4833
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Fax | 480-813-4833
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC1125
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License Number State | AZ
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