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Kevin Michal Andrew Goodman

Marriage & Family Therapist in Grover Beach, CA. Individual provider (NPI-1).

NPI number1306137005
StatusActive
Last updated in NPPESFeb 28, 2025

Details

NPI
1306137005
Entity type
Individual (NPI-1)
Name
Kevin Michal Andrew Goodman
Sex
Male
Sole proprietor
Yes
Enumeration date
Apr 28, 2011
Certification date
Feb 28, 2025
Last updated
Feb 28, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
106H00000X Marriage & Family Therapist104925CAYes

Practice location

1523 Longbranch Ave
Grover Beach, CA 93433-2508

Phone 805-473-7006

Mailing address

2180 Johnson Ave
San Luis Obispo, CA 93401-4558

Phone 805-781-4973

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