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General NPI Number Information
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NPI Number | 1528945227
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Entity Type | Individual
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Provider Name | KRISTEN GOODRICH
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Gender | Male
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/31/2025
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Provider Practice Location Address
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Address Line | 2615 SWEETWATER SPRINGS BLVD STE G
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City | SPRING VALLEY
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State | CA
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Zip | 91978-1725
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Country | US
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Telephone | 619-734-7112
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 161328
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City | SAN DIEGO
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State | CA
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Zip | 92176-1328
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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 |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 17154
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License Number State | CA
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