Provider Demographics
NPI:1275354458
Name:GOOD, GINA ANN (MA)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:ANN
Last Name:GOOD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-2596
Mailing Address - Country:US
Mailing Address - Phone:219-989-7316
Mailing Address - Fax:
Practice Address - Street 1:6915 GRAND AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323-2596
Practice Address - Country:US
Practice Address - Phone:219-989-7316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1363873103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool