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NPI Code Detail

MEDICARE: EMILY DIANE GOODALL AMFT

MEDICARE:   EMILY DIANE GOODALL  AMFT
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
1106H00000XMarriage & Family TherapistAMFT155917CA

General Provider Information

NPI Number : 1659219590
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY DIANE GOODALL AMFT
Provider Business Mailing Address
First Line : PO BOX 223
Second Line :
City : SIERRA MADRE
State : CA
Zip : 91025-0223
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 123 S MONTEBELLO BLVD
Second Line :
City : MONTEBELLO
State : CA
Zip : 90640-4729
Country : US
Telephone Number : 323-887-7900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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Directions to “ EMILY DIANE GOODALL AMFT” Practice Location

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