Healthcare Provider Details

I. General information

NPI: 1457027633
Provider Name (Legal Business Name): WILLIAM MASON GOODE MA, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 ELKS LODGE RD
PAWHUSKA OK
74056-6542
US

IV. Provider business mailing address

923 S PETTIT AVE
HOMINY OK
74035-4549
US

V. Phone/Fax

Practice location:
  • Phone: 539-212-2499
  • Fax: 539-212-2648
Mailing address:
  • Phone: 918-504-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number10475
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10475
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10475
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: