Active NPI
Jennifer Antoinette Goodtracks
- Mental Health Counselor
- Ignacio, CO
National Provider Identifier
1831754332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- NLC0105139
- Practice address
- 69 Capote Dr
Ignacio, CO 81137 - Phone
- (970) 563-4581
- NPI assigned
- May 9, 2019
- Last updated
- May 9, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | NLC0105139 | CO | Primary |
Addresses
Primary practice location
69 Capote Dr
Ignacio, CO 81137
Mailing address
PO Box 535
Ignacio, CO 81137-0535
Phone (970) 563-9207
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NLC0105139 | Other | CO | REGISTERED PSYCHOTHERAPIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NLC0105139 | CO | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Ute Indian Tribe | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Federally Qualified Health Center (FQHC)
- Ignacio, CO
- NPI 1407883309
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557360000000",
"number": "1831754332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 535",
"city": "IGNACIO",
"state": "CO",
"postal_code": "811370535",
"telephone_number": "970-563-9207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "69 CAPOTE DR",
"city": "IGNACIO",
"state": "CO",
"postal_code": "81137",
"telephone_number": "970-563-4581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODTRACKS",
"first_name": "JENNIFER",
"middle_name": "ANTOINETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-09",
"last_updated": "2019-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CO",
"license": "NLC0105139",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTERED PSYCHOTHERAPIST",
"identifier": "NLC0105139",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ignacio, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.