Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tyler Wade Goodman

Individual provider Peer Specialist · NPI 1124884242

Tyler Wade Goodman is a Peer Specialist in Ponca City, Oklahoma. Works from 2 locations. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

93 Noel Ln
Ponca City, OK 74604-5443
Phone: (580) 485-5796
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 93 Noel Ln, Ponca City, OK 74604-5443 — (580) 485-5796

Specialties & licences

Peer Specialist (primary) Taxonomy 175T00000X

Record details

NPI number1124884242
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedFebruary 26, 2024
Last updated in NPPESMarch 20, 2024
Certification dateMarch 20, 2024
Mailing addressGrand Mental Health 407 S Ave, Ponca City, OK 74604-5443

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