Individual
MARK GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
62930 O B RILEY RD STE 200, BEND, OR 97703-9459
(541) 330-1919
Mailing address
399 E 10TH AVE, EUGENE, OR 97401-3380
(541) 868-2004
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
5447
OR
Other
Enumeration date
11/03/2011
Last updated
05/06/2022
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