MEDICARE: SHANIECE SHIRELL 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	LMFT161576	CA

General Provider Information

NPI Number	:	1225764426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIECE SHIRELL GOODMAN

Provider Business Mailing Address
First Line	:	2065 W EL CAMINO AVE APT 634
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-2968
Country	:	US
Telephone Number	:	510-833-3503
Fax Number	:

Provider Business Practice Location Address
First Line	:	2065 W EL CAMINO AVE APT 634
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-2968
Country	:	US
Telephone Number	:	510-833-3503
Fax Number	:

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

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	02/18/2026

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