Provider Demographics
NPI:1780472811
Name:GOODHEART, MATHURIN QUIN
Entity type:Individual
Prefix:
First Name:MATHURIN
Middle Name:QUIN
Last Name:GOODHEART
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 1:2885 N RECORDS AVE APT P102
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6708
Mailing Address - Country:US
Mailing Address - Phone:208-570-2207
Mailing Address - Fax:
Practice Address - Street 1:1905 S TOPAZ WAY UNIT 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4477
Practice Address - Country:US
Practice Address - Phone:208-417-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician