Basic Information
| Provider Information | |||||||||
| NPI: | 1982727947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOUDEAU | ||||||||
| FirstName: | CANDACE | ||||||||
| MiddleName: | Y | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 S BEACH BLVD | ||||||||
| Address2: | #126 | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928043936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235280965 | ||||||||
| FaxNumber: | 3232498367 | ||||||||
| Practice Location | |||||||||
| Address1: | 11905 S CENTRAL AVE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900592836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232499026 | ||||||||
| FaxNumber: | 3232498367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CAS#4488 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.