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NPI Code Detail

MEDICARE: MRS. SHARLA RENEA GODDARD MA, LCDCI

MEDICARE: MRS. SHARLA RENEA GODDARD MA, LCDCI
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
1101YA0400XAddiction (Substance Use Disorder) Counselor61145TX

General Provider Information

NPI Number : 1609652577
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHARLA RENEA GODDARD MA, LCDCI
Provider Business Mailing Address
First Line : 803 S RUSK ST
Second Line :
City : AMARILLO
State : TX
Zip : 79106-6648
Country : US
Telephone Number : 806-374-6688
Fax Number :
Provider Business Practice Location Address
First Line : 803 S RUSK ST
Second Line :
City : AMARILLO
State : TX
Zip : 79106-6648
Country : US
Telephone Number : 806-374-6688
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2023
Last Update Date : 09/06/2023

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