MEDICARE: CHRISTINA GOODALL

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
1	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist	124197	CA
3	106H00000X	Marriage & Family Therapist	LMFT124197	CA

General Provider Information

NPI Number	:	1609315811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA GOODALL

Provider Business Mailing Address
First Line	:	17140 BERNARDO CENTER DR STE 225
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2088
Country	:	US
Telephone Number	:	833-579-4848
Fax Number	:

Provider Business Practice Location Address
First Line	:	17140 BERNARDO CENTER DR STE 225
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2088
Country	:	US
Telephone Number	:	833-579-4848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	04/04/2024

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Directions to “ CHRISTINA GOODALL ” Practice Location

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