Basic Information
| Provider Information | |||||||||
| NPI: | 1649317215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELL GOODEN | ||||||||
| FirstName: | YVONNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BELL | ||||||||
| OtherFirstName: | YVONNE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2821 N VEL R PHILLIPS AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142636000 | ||||||||
| FaxNumber: | 4142632270 | ||||||||
| Practice Location | |||||||||
| Address1: | 2821 N VEL R PHILLIPS AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142636000 | ||||||||
| FaxNumber: | 4142632270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| ParentOrganizationLBN: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3399 | WI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 3399125 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.