Organization
GOODROW FAMILY & YOUTH INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH KRISS GOODROW II M.S., LPCC (PRESIDENT/OWNER)
(505) 239-7459
Entity
Organization
Contact information
Practice address
5100 2ND ST NW, ALBUQUERQUE, NM 87107-4009
(505) 468-7106
(505) 462-9985
Mailing address
10220 AVENIDA VISTA SOL NW, ALBUQUERQUE, NM 87114-5904
(505) 239-7459
(505) 899-4060
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
78151
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
66559251
—
NM
Enumeration date
07/02/2012
Last updated
07/02/2012
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