Provider Demographics
NPI:1265296594
Name:GOODE, TASHA (INTERN)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:GOODE
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705B SE MELODY LN # 139
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4380
Mailing Address - Country:US
Mailing Address - Phone:816-778-6510
Mailing Address - Fax:
Practice Address - Street 1:11695 S BLACKBOB RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1058
Practice Address - Country:US
Practice Address - Phone:913-768-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty