Provider Demographics
NPI:1427083930
Name:GOODMAN & ASSOCIATES, PC
Entity type:Organization
Organization Name:GOODMAN & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CPC, LIMHP
Authorized Official - Phone:402-558-2034
Mailing Address - Street 1:1941 S 42ND ST STE 540
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2986
Mailing Address - Country:US
Mailing Address - Phone:402-558-2034
Mailing Address - Fax:402-614-1540
Practice Address - Street 1:1941 S 42ND ST STE 540
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2986
Practice Address - Country:US
Practice Address - Phone:402-558-2034
Practice Address - Fax:402-614-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid