Provider Demographics
NPI:1548017270
Name:GOODMAN, TAMMY LEE (BC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LEE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 CHESTNUT ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-6976
Mailing Address - Country:US
Mailing Address - Phone:503-779-3662
Mailing Address - Fax:800-554-8519
Practice Address - Street 1:1415 CHESTNUT ST SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-6976
Practice Address - Country:US
Practice Address - Phone:503-779-3662
Practice Address - Fax:800-554-8519
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst