Provider Demographics
NPI:1215668819
Name:GOODMAN, HAYLIE M
Entity type:Individual
Prefix:
First Name:HAYLIE
Middle Name:M
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11412 N 134TH EAST AVE STE C3
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4969
Mailing Address - Country:US
Mailing Address - Phone:918-376-3087
Mailing Address - Fax:
Practice Address - Street 1:11412 N 134TH EAST AVE STE C3
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4969
Practice Address - Country:US
Practice Address - Phone:918-376-3087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst