Provider Demographics
NPI:1245120344
Name:GOON, DERRIK
Entity type:Individual
Prefix:
First Name:DERRIK
Middle Name:
Last Name:GOON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11360 W TOUSSAINT PORTAGE RD
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-9723
Mailing Address - Country:US
Mailing Address - Phone:419-351-1927
Mailing Address - Fax:
Practice Address - Street 1:11360 W TOUSSAINT PORTAGE RD
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449-9723
Practice Address - Country:US
Practice Address - Phone:419-351-1927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty