MEDICARE: CARA LEE GOODMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1194087494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA LEE GOODMAN

Provider Business Mailing Address
First Line	:	9572 SEDONA HILLS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8024
Country	:	US
Telephone Number	:	702-290-2434
Fax Number	:

Provider Business Practice Location Address
First Line	:	3606 N RANCHO DR
Second Line	:	SUITE 142
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3195
Country	:	US
Telephone Number	:	702-278-0984
Fax Number	:	702-651-0535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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Directions to “ CARA LEE GOODMAN ” Practice Location

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