Provider Demographics
NPI:1043857659
Name:GOODMAN, MADELINE
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:817 N PLATT CIR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73170-1115
Mailing Address - Country:US
Mailing Address - Phone:405-693-5742
Mailing Address - Fax:
Practice Address - Street 1:6608 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7326
Practice Address - Country:US
Practice Address - Phone:405-355-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health