Provider Demographics
NPI:1184115271
Name:GOODWIN, MONICA ELIZABETH (MENTAL HEALTH TECH 2)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ELIZABETH
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MENTAL HEALTH TECH 2
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:ELIZABETH
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MENTAL HEALTH TECH 2
Mailing Address - Street 1:3728 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-3718
Mailing Address - Country:US
Mailing Address - Phone:405-550-5748
Mailing Address - Fax:
Practice Address - Street 1:2129 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7024
Practice Address - Country:US
Practice Address - Phone:405-713-5981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator