Healthcare Provider Details
I. General information
NPI: 1003067430
Provider Name (Legal Business Name): DONITA K GOODIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 10/03/2008
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1212 S AIR DEPOT BLVD
MIDWEST CITY OK
73110-4870
US
IV. Provider business mailing address
1212 S AIR DEPOT BLVD STE 23
MIDWEST CITY OK
73110-4860
US
V. Phone/Fax
- Phone: 405-464-9536
- Fax:
- Phone: 405-464-9536
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | 3863 |
| License Number State | OK |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: