Provider Demographics
NPI:1255990743
Name:GOODALL, BREANN MCKENZIE (LCSW)
Entity type:Individual
Prefix:
First Name:BREANN
Middle Name:MCKENZIE
Last Name:GOODALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 WISTFUL VISTA DR APT 15302
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8671
Mailing Address - Country:US
Mailing Address - Phone:319-504-9814
Mailing Address - Fax:
Practice Address - Street 1:6500 EP TRUE PKWY APT 7234
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5277
Practice Address - Country:US
Practice Address - Phone:319-504-9814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical