MEDICARE: LAURA GOOD

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	101YM0800X	Mental Health Counselor	A15558	OR

General Provider Information

NPI Number	:	1841078177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA GOOD

Provider Business Mailing Address
First Line	:	1111 E BURNSIDE ST STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1850
Country	:	US
Telephone Number	:	503-567-8407
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 E BURNSIDE ST STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1850
Country	:	US
Telephone Number	:	503-567-8407
Fax Number	:

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

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	07/08/2025

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Directions to “ LAURA GOOD ” Practice Location

Language	Start Address	Practice Location

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