Healthcare Provider Details

I. General information

NPI: 1225219827
Provider Name (Legal Business Name): BECKY GOODIN LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2007
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16005 PRAIRIE WAY
BASEHOR KS
66007-9737
US

IV. Provider business mailing address

PO BOX 174
TONGANOXIE KS
66086-0174
US

V. Phone/Fax

Practice location:
  • Phone: 913-240-3044
  • Fax:
Mailing address:
  • Phone: 913-240-3044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4402
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: