Provider Demographics
NPI:1811732522
Name:GOAD, MARIAH TARESSA
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:TARESSA
Last Name:GOAD
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:MARS
Other - Middle Name:TARESSA
Other - Last Name:GOAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:630 S RANCHO DR STE D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4849
Mailing Address - Country:US
Mailing Address - Phone:702-996-9505
Mailing Address - Fax:
Practice Address - Street 1:630 S RANCHO DR STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4849
Practice Address - Country:US
Practice Address - Phone:702-996-9505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician