Kevin Michal Andrew Goodman
Individual provider Active NPI Marriage & Family Therapist · Grover Beach, CA
NPI 1306137005 · NPPES record last updated Feb 28, 2025
Key facts
- NPI
- 1306137005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 104925 (CA)
- Practice address
- 1523 Longbranch Ave
Grover Beach, CA 93433-2508 - Phone
- (805) 473-7006
- NPI assigned
- Apr 28, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104925 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 104925 | CA | Yes |
Addresses
Primary practice location
1523 Longbranch Ave
Grover Beach, CA 93433-2508
Mailing address
2180 Johnson Ave
San Luis Obispo, CA 93401-4558
Phone (805) 781-4973
Other providers in Grover Beach, CA
- Xaviera Garza
- Linda Marie Gendron
- Annika Gilbert
- Adelina Gill
- Shana Gitterman
- Spencer Goss
- Christina Grogg
- Sheryl Gross
- Javier Gudino
- Claire Victoria Guittard
All providers in Grover Beach, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.