| Good-elliott Counseling, Llc | |
|
313 S 3rd St Goshen IN 46526-3709 | |
| (574) 535-0880 | |
| (574) 535-0882 |
| Full Name | Good-elliott Counseling, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 313 S 3rd St, Goshen, Indiana |
| Authorized Official Name and Position | Philip David Good-elliott (OWNER) |
| Authorized Official Contact | 5745350880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Good-elliott Counseling, Llc 313 S 3rd St Goshen IN 46526-3709 Ph: (574) 535-0880 | Good-elliott Counseling, Llc 313 S 3rd St Goshen IN 46526-3709 Ph: (574) 535-0880 |
| NPI Number | 1659876126 |
|---|---|
| Provider Enumeration Date | 03/27/2018 |
| Last Update Date | 03/27/2018 |
| Medicare PECOS PAC ID | 1759644115 |
|---|---|
| Medicare Enrollment ID | O20180417002072 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659876126 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 340004467A (Indiana) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 34004467A (Indiana) | Secondary |
| Provider Name | Philip David Good-elliott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033126446 PECOS PAC ID: 9931131265 Enrollment ID: I20050907000666 |
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