Individual provider Active NPI

Monica J Overberg Goodrick, LMHC, LCPC

  • Mental Health Counselor
  • Davenport, IA
National Provider Identifier
1124265392
Registry record updated Jan 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
001392 Issued in IA
Practice address
2322 E Kimberly Rd Ste 265N
Davenport, IA 52807-7224
Phone
(563) 526-3481
Fax
(563) 526-7631
NPI assigned
Jan 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 180007087 IL
Mental Health Counselor 101YM0800X 001392 IA Primary

Addresses

Primary practice location

2322 E Kimberly Rd Ste 265N
Davenport, IA 52807-7224

Mailing address

2322 E Kimberly Rd Ste 265N
Davenport, IA 52807-7224
Phone (563) 526-3481

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240112000229 IA Practitioner - Mental Health Counselor 1658722848 Practice locations: Davenport, IA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
180007087ILMDCounselor
001392IAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Monica'S Psychotherapy and Healing, PLLC Mental Health Current Accepting new patients

Locations

2322 E Kimberly Rd
Ste 265N
Davenport, IA 52807
Phone (563) 349-7948

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704499200000",
    "number": "1124265392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2322 E KIMBERLY RD STE 265N",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528077224",
            "telephone_number": "563-526-3481",
            "fax_number": "563-526-7631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2322 E KIMBERLY RD STE 265N",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528077224",
            "telephone_number": "563-526-3481",
            "fax_number": "563-526-7631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OVERBERG GOODRICK",
        "first_name": "MONICA",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "LMHC, LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-09",
        "last_updated": "2024-01-06",
        "certification_date": "2024-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "180007087",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "001392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.