Doctor Name: | MS. SUSAN D GOODALE |
NPI Number: | 1407048077 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | |
Business Practice Address: | 7210 N Villa Lake Dr Ste D Behavioral Health Advantages Inc Peoria, IL - 61614 |
Business Phone Number: | 3095891011 |
Business Fax Number: | 3095891019 |
Mailing Address: | 7210 N Villa Lake Dr, Ste D Behavioral Health Advantages Inc PEORIA |
State: | IL |
Postal Code: | 61614 |
Phone Number: | 3095891011 |
Fax Number: | 3095891019 |
NPI Enumeration Date: | 08/16/2007 |
NPI Last Update Date: | 08/16/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |