Provider Demographics
NPI:1366564080
Name:GOUDEAU, BERNADINE (COUNSELOR)
Entity type:Individual
Prefix:
First Name:BERNADINE
Middle Name:
Last Name:GOUDEAU
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 E 116TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-1602
Mailing Address - Country:US
Mailing Address - Phone:213-280-1012
Mailing Address - Fax:323-563-7087
Practice Address - Street 1:11905 S CENTRAL AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-2836
Practice Address - Country:US
Practice Address - Phone:323-249-9026
Practice Address - Fax:323-249-8367
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4282101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor