WALLACE GOODMAN (NPI# 1427488055) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427488055 |
| Entity Type | Individual |
| Full Name | WALLACE GOODMAN |
| Practice Address |
501 Highway J N Hayti MO 63851 |
| Mailing Address |
2009 Southwind Cv Dyersburg TN 38024-8875 |
| Practice Telephone | 5733592600 |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2013-11-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
2011024580 | MO | Behavioral Health & Social Service Providers |
| Street Address |
501 HIGHWAY J N |
| City | HAYTI |
| State | MO |
| Zip Code | 63851 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619518032 | Mcpherson Medical & Diagnostic, LLC | Clinic/Center | 110 Us Hwy 61 N, Ste B, Hayti, MO 63851 | 2019-10-07 |
| 1225525744 | Roosevelt Dismukes Jr. | Behavior Technician | 500 Highway 61 N J, Hayti, MO 63851 | 2018-04-19 |
| 1417461625 | Rivian Ricole Hill | Recreation Therapist | 501 Highway 61 J N, Hayti, MO 63851 | 2017-11-27 |
| 1750761169 | Lindsey Moody | Case Manager/Care Coordinator | 909 East Reed Street, Hayti, MO 63851 | 2015-06-02 |
| 1710375811 | Jeremy Winstead | Technician, Other | 500 Highway J North, Hayti, MO 63851 | 2014-12-26 |
| 1164810206 | Teresa Ward | Registered Nurse | 589 Hwy J, Hayti, MO 63851 | 2014-12-23 |
| 1780081463 | Heather Brown | Case Manager/Care Coordinator | 581 Hwy J, Hayti, MO 63851 | 2014-11-25 |
| 1184029241 | Cheryl Byrd | Case Manager/Care Coordinator | 581 Highway J, Hayti, MO 63851 | 2014-10-30 |
| 1114320827 | Toshia Russell | Licensed Practical Nurse | 579 North Highway J, Hayti, MO 63851 | 2014-10-08 |
| 1992104301 | Lora Hawes | Case Manager/Care Coordinator | 581 Hwy J North, Hayti, MO 63851 | 2014-08-21 |
| Find all providers in zip 63851 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578913315 | Melisa Renee Richardson | Counselor | 812 E Washington St, Hayti, MO 63851-1752 | 2016-06-13 |
| 1689820771 | Debra Hampton | Counselor | 500 Us Hwy 61 N, Hayti, MO 63851 | 2008-08-08 |
| 1700086931 | Deborah June Faulkner | Counselor | Hwy J North, Hayti, Hayti, MO 63851 | 2007-07-25 |
| 1407057755 | Henry Thomas Altmeyer | Counselor | 500 Hwy J North, Hayti, Hayti, MO 63851 | 2007-05-31 |
| 1093367351 | Rebecca Sue Shelton | Counselor | 500 Highway J, Hayti, MO 63851-1200 | 2019-07-16 |
| 1497211510 | Tammy Lynn Barnes | Counselor | 500 Highway J, Hayti, MO 63851-1200 | 2019-02-13 |
| 1356859326 | Derek Luther Jackson | Counselor | 581 Highway J North, Hayti, MO 63851 | 2018-01-12 |
| 1154866531 | Doyletta Thrasher | Counselor | 500 Highway J, Hayti, MO 63851-1200 | 2016-12-21 |
| 1063954014 | Ronnie Sells | Counselor | 500 Highway J, Hayti, MO 63851-1200 | 2016-11-08 |
| 1346651775 | Jessica Marie Walker | Counselor | 500 Hwy J, Hayti, MO 63851 | 2014-05-20 |
| Find all providers in HAYTI | ||||
Please comment or provide details below to improve the information on WALLACE GOODMAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.