Provider Demographics
NPI:1053950501
Name:GOODMAN, TANYA A (MS, CAADC, LPC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:A
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MS, CAADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S NICE ST
Mailing Address - Street 2:
Mailing Address - City:FRACKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17931-2111
Mailing Address - Country:US
Mailing Address - Phone:570-401-5988
Mailing Address - Fax:
Practice Address - Street 1:310 S NICE ST
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2111
Practice Address - Country:US
Practice Address - Phone:570-401-5988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012051101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional