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General NPI Number Information
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NPI Number | 1871842054
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Entity Type | Individual
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Provider Name | LISA M GOODSON
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Gender | Female
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 02/08/2018
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Provider Practice Location Address
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Address Line | 175 E HAWTHORN PKWY
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City | VERNON HILLS
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State | IL
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Zip | 60061-1463
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Country | US
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Telephone | 847-868-3435
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 VISTA CT APT 201
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City | SCHAUMBURG
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State | IL
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Zip | 60193-5172
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Country | US
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Telephone | 708-374-8450
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 178.012011
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License Number State | IL
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