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NPI Code Detail

MEDICARE: MS. TYRUS D GOODE LPCA #281717

MEDICARE: MS. TYRUS D GOODE LPCA #281717
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 Counselor281717KY

General Provider Information

NPI Number : 1790630465
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TYRUS D GOODE LPCA #281717
Provider Business Mailing Address
First Line : 3934 DIXIE HWY STE 210
Second Line :
City : LOUISVILLE
State : KY
Zip : 40216-4176
Country : US
Telephone Number : 502-807-9085
Fax Number : 502-855-4973
Provider Business Practice Location Address
First Line : 3934 DIXIE HWY STE 210
Second Line :
City : LOUISVILLE
State : KY
Zip : 40216-4176
Country : US
Telephone Number : 502-807-9085
Fax Number : 502-855-4973
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2026
Last Update Date : 02/27/2026

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Directions to “ MS. TYRUS D GOODE LPCA #281717” Practice Location

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