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NPI Code Detail

MEDICARE: BRANDIE CLENDENEN GOOD LCDC III

MEDICARE: BRANDIE CLENDENEN GOOD LCDC III
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2175T00000XPeer Specialist

General Provider Information

NPI Number : 1548934367
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDIE CLENDENEN GOOD LCDC III
Provider Business Mailing Address
First Line : 2727 S 3RD ST
Second Line :
City : IRONTON
State : OH
Zip : 45638-2760
Country : US
Telephone Number : 740-534-2100
Fax Number :
Provider Business Practice Location Address
First Line : 2727 S 3RD ST
Second Line :
City : IRONTON
State : OH
Zip : 45638-2760
Country : US
Telephone Number : 740-534-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2021
Last Update Date : 01/13/2026

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Directions to “ BRANDIE CLENDENEN GOOD LCDC III” Practice Location

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