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NPI Code Detail

MEDICARE: ETHAN GOOBY

MEDICARE: ETHAN GOOBY
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
1106S00000XBehavior Technician00023914AZ

General Provider Information

NPI Number : 1295601797
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN GOOBY
Provider Business Mailing Address
First Line : 996 ROYAL MARCO WAY
Second Line :
City : MARCO ISLAND
State : FL
Zip : 34145-1829
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 310 N WILMOT RD STE 306
Second Line :
City : TUCSON
State : AZ
Zip : 85711-2628
Country : US
Telephone Number : 520-467-7487
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2025
Last Update Date : 10/13/2025

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Directions to “ ETHAN GOOBY ” Practice Location

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