Provider Demographics
NPI:1528849510
Name:GOODFELLOW, JOSEPH (LMHC-A)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GOODFELLOW
Suffix:
Gender:M
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:TOKELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98590-0500
Mailing Address - Country:US
Mailing Address - Phone:360-267-8263
Mailing Address - Fax:
Practice Address - Street 1:2373 OLD TOKELAND RD BLDG E
Practice Address - Street 2:2373 OLD TOKELAND RD
Practice Address - City:TOKELAND
Practice Address - State:WA
Practice Address - Zip Code:98590-9859
Practice Address - Country:US
Practice Address - Phone:360-267-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61420842101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health