Provider Demographics
NPI:1598920803
Name:GOODNER, MARY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:GOODNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:GOODNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2408 W CLAY DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3168
Mailing Address - Country:US
Mailing Address - Phone:615-444-2486
Mailing Address - Fax:
Practice Address - Street 1:500 PARK AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3721
Practice Address - Country:US
Practice Address - Phone:615-449-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4981OtherLICENSED CLINICAL SOCIAL WORKER LICENSE NUMBER