Provider Demographics
NPI:1598479321
Name:GOUDEAU, ALLIN
Entity Type:Individual
Prefix:
First Name:ALLIN
Middle Name:
Last Name:GOUDEAU
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 1:7252 S 87TH EAST AVE # 52-106
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3148
Mailing Address - Country:US
Mailing Address - Phone:918-625-8492
Mailing Address - Fax:
Practice Address - Street 1:7252 S 87TH EAST AVE # 52-106
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3148
Practice Address - Country:US
Practice Address - Phone:918-625-8492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)