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General NPI Number Information
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NPI Number | 1285151530
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Entity Type | Individual
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Provider Name | ALLISON NICOLE GOODRICH
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Gender | Female
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 2215 NW CACHE RD STE 107
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City | LAWTON
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State | OK
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Zip | 73505-5258
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Country | US
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Telephone | 580-351-9998
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 E GORE BLVD APT 1625
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City | LAWTON
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State | OK
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Zip | 73501-6717
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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