Healthcare Provider Details

I. General information

NPI: 1588109482
Provider Name (Legal Business Name): RICHARD RAY GODDARD JR. PMHNP-BC, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date: 04/07/2025
Reactivation Date: 04/21/2025

III. Provider practice location address

789 WHITE POND DR
AKRON OH
44320-4203
US

IV. Provider business mailing address

789 WHITE POND DR
AKRON OH
44320-4203
US

V. Phone/Fax

Practice location:
  • Phone: 330-840-5170
  • Fax:
Mailing address:
  • Phone: 330-840-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025041114
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024195058
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-84794-072
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0042065
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: