Provider Demographics
NPI:1922812502
Name:GOOD, TILA
Entity type:Individual
Prefix:
First Name:TILA
Middle Name:
Last Name:GOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-2070
Mailing Address - Country:US
Mailing Address - Phone:402-686-6576
Mailing Address - Fax:
Practice Address - Street 1:3032 AVENUE C
Practice Address - Street 2:
Practice Address - City:COUNCIL BLFS
Practice Address - State:IA
Practice Address - Zip Code:51501-2070
Practice Address - Country:US
Practice Address - Phone:402-686-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty