Provider Demographics
NPI:1295824514
Name:GOOD, NANCY JAYNE (MSW, LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JAYNE
Last Name:GOOD
Suffix:
Gender:F
Credentials:MSW, LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 NE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5456
Mailing Address - Country:US
Mailing Address - Phone:202-740-0604
Mailing Address - Fax:
Practice Address - Street 1:6230 NE 23RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5456
Practice Address - Country:US
Practice Address - Phone:202-740-0604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL7306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008905932Medicaid
VA263172000OtherMAGELLAN
VA110407OtherANTHEM
VA110407OtherBLUE CROSS OR TRIGON
VAA086470OtherSENTARA
VA800001898Medicare ID - Type Unspecified