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Wallace Goodman
Addiction (Substance Use Disorder) Counselor in Hayti, Missouri
NPI 1427488055

Wallace Goodman is an Addiction (Substance Use Disorder) Counselor based in Dyersburg, MO and is specialized in Addiction (Substance Use Disorder). Wallace Goodman practices in Hayti, MO. The NPI Number for Wallace Goodman is 1427488055 and holds a License No. 2011024580 (Missouri).

The current practice location address for Wallace Goodman is 501 Highway J N, Hayti, MO and can be reached out via phone at 573-359-2600.

Location: 501 Highway J N, Hayti, MO, 38024-8875
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1427488055
Provider Name
Wallace Goodman
Credential
Provider Entity Type
Individual
Gender
Male
Address
501 Highway J N, Hayti, MO, 38024-8875
Phone Number
573-359-2600
Fax Number
Provider Enumeration Date
11/18/2013
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
501 Highway J N
City
Hayti
State
Missouri
Zip
63851
Phone Number
573-359-2600
Fax Number
person
Provider Business Mailing Address Details
Address
501 Highway J N
City
Hayti
State
Missouri
Zip
63851
Phone Number
573-359-2600
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
2011024580 (Missouri)
Definition
Definition to come...
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