Provider Demographics
NPI:1336837897
Name:GOODEN, LEVI E
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:E
Last Name:GOODEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W HERMOSA DR
Mailing Address - Street 2:NW-203
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:303-759-4666
Mailing Address - Fax:
Practice Address - Street 1:2111 E BASELINE RD STE A2
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1505
Practice Address - Country:US
Practice Address - Phone:480-489-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician