Provider Demographics
NPI:1164216362
Name:GOOD GRIEF COUNSELING LLC
Entity type:Organization
Organization Name:GOOD GRIEF COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:QUANSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-860-9260
Mailing Address - Street 1:140 FERGUSON LN
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-7932
Mailing Address - Country:US
Mailing Address - Phone:208-860-9260
Mailing Address - Fax:
Practice Address - Street 1:140 FERGUSON LN
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-7932
Practice Address - Country:US
Practice Address - Phone:208-860-9260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health