Provider Demographics
NPI:1063993608
Name:GOODFELLOW, MEGAN LACHELLE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LACHELLE
Last Name:GOODFELLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LACHELLE
Other - Last Name:RUESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16219 285TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8700
Mailing Address - Country:US
Mailing Address - Phone:253-398-9428
Mailing Address - Fax:
Practice Address - Street 1:16219 285TH STREET CT E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8700
Practice Address - Country:US
Practice Address - Phone:253-398-9428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61334437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health