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General NPI Number Information
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NPI Number | 1659876126
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Entity Type | Organization
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Legal Business Name | GOOD-ELLIOTT COUNSELING, LLC
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 313 S 3RD ST
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City | GOSHEN
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State | IN
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Zip | 46526-3709
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Country | US
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Telephone | 574-535-0880
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Fax | 574-535-0882
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Provider Business Mailing Address
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Address Line | 313 S 3RD ST
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City | GOSHEN
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State | IN
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Zip | 46526-3709
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Country | US
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Telephone | 574-535-0880
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Fax | 574-535-0882
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Authorized Official
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Title or Position | OWNER
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Name | PHILIP DAVID GOOD-ELLIOTT
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Credential | MSW, LCSW
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Telephone | 574-535-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 34004467A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 340004467A
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License Number State | IN
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