Provider Demographics
NPI:1811587975
Name:GOODMAN, TAMARA LEA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LEA
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BLACKSMITH XING
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IN
Mailing Address - Zip Code:46793-0090
Mailing Address - Country:US
Mailing Address - Phone:260-610-0389
Mailing Address - Fax:
Practice Address - Street 1:3810 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1102
Practice Address - Country:US
Practice Address - Phone:260-460-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000356A101YA0400X
IN39001925A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)