Provider Demographics
NPI:1033482740
Name:GOLDMAN, MICHAEL ALAN (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALAN
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 MINOR HILL RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-9628
Mailing Address - Country:US
Mailing Address - Phone:573-864-5107
Mailing Address - Fax:
Practice Address - Street 1:1005 CHERRY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7900
Practice Address - Country:US
Practice Address - Phone:573-864-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS000723101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional