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NPI Code Detail

MEDICARE: CHRISTIAN GOLDSMITH

MEDICARE: CHRISTIAN 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
1101YA0400XAddiction (Substance Use Disorder) Counselor8489MO

General Provider Information

NPI Number : 1972958924
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTIAN GOLDSMITH
Provider Business Mailing Address
First Line : 19488 STACEY CT
Second Line :
City : BOONVILLE
State : MO
Zip : 65233-3537
Country : US
Telephone Number : 660-537-3544
Fax Number :
Provider Business Practice Location Address
First Line : 1301 VANDIVER DR STE Y
Second Line :
City : COLUMBIA
State : MO
Zip : 65202-3918
Country : US
Telephone Number : 573-449-8338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2016
Last Update Date : 04/27/2016

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Directions to “ CHRISTIAN GOLDSMITH ” Practice Location

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