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NPI Code Detail

MEDICARE: MR. THOMAS G GOODMAN LPC

MEDICARE: MR. THOMAS G GOODMAN LPC
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
1101YP2500XProfessional Counselor19383TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27514LCOTHERTXBLUE CROSS BLUE SHIELD TX

General Provider Information

NPI Number : 1508941212
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS G GOODMAN LPC
Provider Business Mailing Address
First Line : PO BOX 632040
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75963-2040
Country : US
Telephone Number : 936-585-7121
Fax Number :
Provider Business Practice Location Address
First Line : 1309 S UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75961-6486
Country : US
Telephone Number : 936-560-5668
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 04/02/2024

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