Provider Demographics
NPI:1326514977
Name:GOOD, SHEILA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:ANN
Last Name:GOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HAMNER PARK RD
Mailing Address - Street 2:
Mailing Address - City:CARNEY
Mailing Address - State:OK
Mailing Address - Zip Code:74832-9707
Mailing Address - Country:US
Mailing Address - Phone:580-761-6996
Mailing Address - Fax:
Practice Address - Street 1:205 HAMNER PARK RD
Practice Address - Street 2:
Practice Address - City:CARNEY
Practice Address - State:OK
Practice Address - Zip Code:74832-9707
Practice Address - Country:US
Practice Address - Phone:580-761-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29022164W00000X
OK61041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty