Provider Demographics
NPI:1992833016
Name:GOODMAN, NOLAN L (BS)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:L
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4502
Mailing Address - Country:US
Mailing Address - Phone:931-388-6452
Mailing Address - Fax:
Practice Address - Street 1:321 W 7TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3132
Practice Address - Country:US
Practice Address - Phone:931-490-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional