1780024034 NPI number — MR. RONALD DWIGHT GOODE M.A., LMFT

Table of content: MR. RONALD DWIGHT GOODE M.A., LMFT (NPI 1780024034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780024034 NPI number — MR. RONALD DWIGHT GOODE M.A., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOODE
Provider First Name:
RONALD
Provider Middle Name:
DWIGHT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780024034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5042 WILSHIRE BLVD # 564
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90036-4305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-216-8751
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7003 N FIGUEROA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90042-1247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-543-4235
Provider Business Practice Location Address Fax Number:
323-344-7382
Provider Enumeration Date:
07/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LMFT102322 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LMFT102322 . This is a "CALIFORNIA BOARD OF BEHAVIORAL SCIENCES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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