Wallace Goodman

NPI 1427488055 - Counselor - 101YA0400X

NPI Details
NPI 1427488055
Gender Male
Enumeration Date 11/18/2013
Last Updated 11/18/2013
Entity Type Individual
Active Over 3 years ago
Practice Location
501 HIGHWAY J N
HAYTI MO, 63851, US
Phone (573) 359-2600
Fax
Business Location
2009 SOUTHWIND CV
DYERSBURG TN, 38024-8875, US
Phone
Fax
Toxanomy
Taxonomy Code 101YA0400X
License State Missouri
License Number 2011024580
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According to our database, Wallace Goodman NPI is 1427488055, taxonomy code is 101YA0400X and license number is 2011024580, license state is located at Missouri. Wallace Goodman physically located at 501 Highway J N, Hayti MO, 63851. NPI Number Wallace Goodman has the Individual type.

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1427488055 NPI number is provided on an as is basis without warranty of any kind. 1427488055 is maintained by the National Plan & Provider Enumeration System. The contents of Wallace Goodman are for informational purposes only.