Provider Demographics
NPI:1275352288
Name:GOODSON, JAMIE (MA, LADC-MH-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GOODSON
Suffix:
Gender:F
Credentials:MA, LADC-MH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 MEMORIAL SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2228
Mailing Address - Country:US
Mailing Address - Phone:405-464-9179
Mailing Address - Fax:
Practice Address - Street 1:4808 JAMES LN
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6693
Practice Address - Country:US
Practice Address - Phone:405-438-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)