Provider Demographics
NPI:1760929673
Name:GOODNER, CHAD ALAN
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ALAN
Last Name:GOODNER
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 1:1465 E 52ND ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-5707
Mailing Address - Country:US
Mailing Address - Phone:918-237-7706
Mailing Address - Fax:
Practice Address - Street 1:401 S BOSTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-4016
Practice Address - Country:US
Practice Address - Phone:918-237-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician