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NPI Code Detail

MEDICARE: TYRON GOLDSMITH

MEDICARE: TYRON GOLDSMITH
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1902119977
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYRON GOLDSMITH
Provider Business Mailing Address
First Line : 2404 NW 119TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-7408
Country : US
Telephone Number : 405-206-1992
Fax Number :
Provider Business Practice Location Address
First Line : 2404 NW 119TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-7408
Country : US
Telephone Number : 405-206-1992
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2010
Last Update Date : 07/20/2010

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Directions to “ TYRON GOLDSMITH ” Practice Location

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