Provider Demographics
NPI:1942763644
Name:GOODE, CASEY NICHOLE (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:NICHOLE
Last Name:GOODE
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 JACKSON PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1507
Mailing Address - Country:US
Mailing Address - Phone:254-482-2999
Mailing Address - Fax:
Practice Address - Street 1:46 JACKSON PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1507
Practice Address - Country:US
Practice Address - Phone:254-482-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALCKG-0108-7506103TS0200X
TX34740103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool