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TERA GOODMAN
Developmental Disabilities >> Clinic/Center >> Ambulatory Health Care FacilitiesRegistrant NPI Number: 1215348552
Individual Registrant: TERA GOODMAN
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
15 BARBER DR HARDY, AR 72542-9109 US
Tel: 870-994-3103 Fax: --
Tel: 870-994-3103 Fax: --
Contact information for business:
15 BARBER DR HARDY, AR 72542-9109 US
Tel: -- Fax: --
Tel: -- Fax: --
Registration Information:
NPI: 1215348552
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 261QD1600X | Ambulatory Health Care Facilities Clinic/Center Developmental Disabilities |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
