Healthcare Provider Details

I. General information

NPI: 1558058974
Provider Name (Legal Business Name): RYANNE GOODMAN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 MEDINA RD
MEDINA OH
44256-5333
US

IV. Provider business mailing address

1136 WARREN DR
BRUNSWICK OH
44212-3008
US

V. Phone/Fax

Practice location:
  • Phone: 330-241-4444
  • Fax:
Mailing address:
  • Phone: 440-212-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM.2400313
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: