Provider Demographics
NPI:1619227105
Name:GOODE, PAUL EDWARD (PLPC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:GOODE
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKLIN
Mailing Address - State:MO
Mailing Address - Zip Code:65274
Mailing Address - Country:US
Mailing Address - Phone:416-660-1045
Mailing Address - Fax:
Practice Address - Street 1:412 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEW FRANKLIN
Practice Address - State:MO
Practice Address - Zip Code:65274
Practice Address - Country:US
Practice Address - Phone:417-770-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012029454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional