Individual
JENNIFER ANTOINETTE GOODTRACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
69 CAPOTE DR, IGNACIO, CO 81137
(970) 563-4581
Mailing address
PO BOX 535, IGNACIO, CO 81137-0535
(970) 563-9207
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
NLC0105139
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NLC0105139
REGISTERED PSYCHOTHERAPIST
CO
Enumeration date
05/09/2019
Last updated
05/09/2019
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