Basic Information
| Provider Information | |||||||||
| NPI: | 1952639965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODBAR | ||||||||
| FirstName: | AIMEE | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1009 N. WAHSATCH AVE. | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7069414100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 629 N. WEBER ST. | ||||||||
| Address2: | SUITE #4 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7069414100 | ||||||||
| FaxNumber: | 7195726299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2009 | ||||||||
| LastUpdateDate: | 12/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 6406 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.