Provider Demographics
NPI:1184253502
Name:EMILY L. GOODMAN PC
Entity type:Organization
Organization Name:EMILY L. GOODMAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP LADC
Authorized Official - Phone:402-560-4156
Mailing Address - Street 1:701 P ST STE 303
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-1356
Mailing Address - Country:US
Mailing Address - Phone:402-560-4156
Mailing Address - Fax:
Practice Address - Street 1:701 P ST STE 303
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-1356
Practice Address - Country:US
Practice Address - Phone:402-560-4156
Practice Address - Fax:402-267-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1026822500Medicaid