Provider Demographics
NPI:1730759614
Name:GOODS, CRYSTAL (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:GOODS
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 S MICHIGAN AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4393
Mailing Address - Country:US
Mailing Address - Phone:773-923-3103
Mailing Address - Fax:773-200-3820
Practice Address - Street 1:332 N MICHIGAN AVE
Practice Address - Street 2:STE 900
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604
Practice Address - Country:US
Practice Address - Phone:773-923-3103
Practice Address - Fax:773-200-3820
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2025-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025394363LP0808X
OHAPRN.CPN.0029178363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health