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General NPI Number Information
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NPI Number | 1629039854
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Entity Type | Individual
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Provider Name | MARK DAVID GOODMAN PHD FPPR
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 125 W. 2ND AVENUE SUITE E
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City | HUTCHINSON
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State | KS
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Zip | 67501-5300
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Country | US
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Telephone | 620-663-4802
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Fax | 620-663-9867
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Provider Business Mailing Address
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Address Line | PO BOX 1221
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City | HUTCHINSON
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State | KS
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Zip | 67504-1221
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Country | US
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Telephone | 620-663-4802
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Fax | 620-663-9867
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 374
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License Number State | KS
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