| Doctor Name: | KRISTY DIANE GOODSON |
| NPI Number: | 1194156216 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | LMSW 33400 |
| Business Practice Address: | 337 W 1st N Apt B Rexburg, ID - 834401403 |
| Business Phone Number: | 2083514643 |
| Business Fax Number: | |
| Mailing Address: | 337 W 1st N Apt B, REXBURG |
| State: | ID |
| Postal Code: | 834401403 |
| Phone Number: | 2083514643 |
| Fax Number: | |
| NPI Enumeration Date: | 11/30/2013 |
| NPI Last Update Date: | 11/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LMSW 33400 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |