Organization
MARK D. GOODMAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK D. GOODMAN PHD, FPPR (LICENSED PSYCHOLOGIST)
(620) 727-6569
Entity
Organization
Contact information
Practice address
125 W 2ND AVE, SUITE E, HUTCHINSON, KS 67501-5300
(620) 663-4802
(620) 663-9867
Mailing address
125 W 2ND AVE, SUITE E, HUTCHINSON, KS 67501-5300
(620) 663-4802
(620) 663-9867
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
374
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100237680A
—
KS
Enumeration date
08/10/2010
Last updated
08/10/2010
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