Provider Demographics
NPI:1487900221
Name:GOODELL, KRISTEN (LMFT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GOODELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 CORTE DEL NOGAL STE K
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1414
Mailing Address - Country:US
Mailing Address - Phone:760-517-6564
Mailing Address - Fax:
Practice Address - Street 1:2075 CORTE DEL NOGAL STE K
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1414
Practice Address - Country:US
Practice Address - Phone:760-517-6564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76021106H00000X
CA98258106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist