Individual
MR. KENNETH KRISS GOODROW II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPCC, NCC, CCMHC
Contact information
Practice address
3949 CORRALES RD STE 105, CORRALES, NM 87048-9347
(505) 239-7459
(505) 899-4060
Mailing address
4101 CORRALES RD UNIT 520, CORRALES, NM 87048-4020
(505) 239-7459
(505) 899-4060
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0078151
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09881522
—
NM
Enumeration date
09/26/2006
Last updated
11/14/2024
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