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General NPI Number Information
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NPI Number | 1396091740
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Entity Type | Individual
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Provider Name | DEMITRA JAMETTE GOODLOE MA LPC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 1133 LINCOLN ST
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City | DENVER
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State | CO
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Zip | 80203-2110
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Country | US
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Telephone | 303-832-6622
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Fax | 303-863-0705
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Provider Business Mailing Address
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Address Line | 2055 S IOLA CT
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City | AURORA
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State | CO
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Zip | 80014-1027
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Country | US
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Telephone | 720-331-9077
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Fax | 303-780-9192
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-11706
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License Number State | CO
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