MEDICARE: MRS. JOANNA LABETTE GOLLIDAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	117093	TX

General Provider Information

NPI Number	:	1912858457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOANNA LABETTE GOLLIDAY

Provider Business Mailing Address
First Line	:	115 E MAIN ST
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75652-3167
Country	:	US
Telephone Number	:	903-646-1326
Fax Number	:	903-392-8267

Provider Business Practice Location Address
First Line	:	854 SW BIG BEND TRL
Second Line	:
City	:	GLEN ROSE
State	:	TX
Zip	:	76043-4413
Country	:	US
Telephone Number	:	903-646-1326
Fax Number	:	903-392-8267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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