Provider Demographics
NPI:1669519310
Name:GOOD, JACQUELINE CLAIRE (MFT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CLAIRE
Last Name:GOOD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:2045 ABERDEEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-9723
Mailing Address - Country:US
Mailing Address - Phone:707-585-1110
Mailing Address - Fax:
Practice Address - Street 1:825 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4108
Practice Address - Country:US
Practice Address - Phone:707-478-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43442106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist