Healthcare Provider Details

I. General information

NPI: 1043142433
Provider Name (Legal Business Name): REBECCA LYNN GOODMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 NW 43RD ST
BETHANY OK
73008
US

IV. Provider business mailing address

6710 NW 43RD ST
BETHANY OK
73008
US

V. Phone/Fax

Practice location:
  • Phone: 405-625-0275
  • Fax:
Mailing address:
  • Phone: 405-625-0275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12544
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: