Individual
MATTHEW GERALD GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6651 CHIPPEWA ST STE 224, SAINT LOUIS, MO 63109-2531
(314) 645-6840
Mailing address
500 ANNA ST LOT 31, SWANSEA, IL 62226-3902
(618) 550-0819
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
178.008168
IL
Other
Enumeration date
09/17/2012
Last updated
09/17/2012
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