Provider Demographics
NPI:1871208934
Name:GOODE, JAMES ALEXANDER
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALEXANDER
Last Name:GOODE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-3441
Mailing Address - Country:US
Mailing Address - Phone:602-815-4504
Mailing Address - Fax:
Practice Address - Street 1:1209 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-3441
Practice Address - Country:US
Practice Address - Phone:602-815-4504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician