Provider Demographics
NPI:1437640760
Name:GOODWIN-DALY, TONYA M (PLMHP, PLADC,)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:M
Last Name:GOODWIN-DALY
Suffix:
Gender:F
Credentials:PLMHP, PLADC,
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:M
Other - Last Name:GOODWIN-DALY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLMHP, PLADC
Mailing Address - Street 1:9910 N 48TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-1548
Mailing Address - Country:US
Mailing Address - Phone:402-813-8244
Mailing Address - Fax:
Practice Address - Street 1:9910 N 48TH ST STE 111
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-1548
Practice Address - Country:US
Practice Address - Phone:402-813-8244
Practice Address - Fax:844-486-0274
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1711101YA0400X
NE12089101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026811800Medicaid