Provider Demographics
NPI:1023884384
Name:GOAD, SHELLEY I
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:I
Last Name:GOAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 BLUEBERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-7305
Mailing Address - Country:US
Mailing Address - Phone:214-622-7543
Mailing Address - Fax:
Practice Address - Street 1:259 BLUEBERRY HILL RD
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-7305
Practice Address - Country:US
Practice Address - Phone:214-622-7543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCAD0224081101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)