Provider Demographics
NPI:1679226195
Name:GOAD, MARIAH (LMHC)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:GOAD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:
Other - Last Name:BRUNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2205 N WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1602
Mailing Address - Country:US
Mailing Address - Phone:765-287-1922
Mailing Address - Fax:
Practice Address - Street 1:2205 N WHEELING AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1602
Practice Address - Country:US
Practice Address - Phone:765-287-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001251A101YM0800X
IN39004388A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health