Healthcare Provider Details

I. General information

NPI: 1891035614
Provider Name (Legal Business Name): SUE GOODMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 MARLBERRY PL
HENDERSON NV
89015-7475
US

IV. Provider business mailing address

667 MARLBERRY PL
HENDERSON NV
89015-7475
US

V. Phone/Fax

Practice location:
  • Phone: 313-732-7332
  • Fax: 702-388-4358
Mailing address:
  • Phone: 313-732-7332
  • Fax: 702-388-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNV
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: