Mr De'rese Zyire Gooden, NCC, LCMHC, CCHT is a
Prevention Professional based in Dayton, Ohio. Mr De'rese Zyire Gooden is licensed to practice in Ohio (license number C.1700611) and his current practice location is
31 S Main St, Dayton, Ohio. He can be reached at his office (for appointments etc.) via phone at
(937) 860-1038.
NPI number for Mr De'rese Zyire Gooden is 1265957914 and his current mailing address is 31 S Main St, Dayton, Ohio. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1265957914.
Healthcare Provider's Profile
| Full Name | Mr De'rese Zyire Gooden |
|---|
| Gender | Male |
|---|
| Speciality | Prevention Professional |
|---|
| Location | 31 S Main St, Dayton, Ohio |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1265957914
- Provider Enumeration Date: 08/03/2017
- Last Update Date: 01/05/2025
Medical Identifiers
Medical identifiers for Mr De'rese Zyire Gooden such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1265957914 | NPI | - | NPPES |
| 0307155 | Medicaid | OH | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | C.1700611 (Ohio) | Secondary |
| 102L00000X | Psychoanalyst | 11725 (Ohio) | Secondary |
| 405300000X | Prevention Professional | C.1700611 (Ohio) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr De'rese Zyire Gooden is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr De'rese Zyire Gooden, NCC, LCMHC, CCHT
31 S Main St,
Dayton, OH 45402-2070
Ph: (937) 860-1038 | Mr De'rese Zyire Gooden, NCC, LCMHC, CCHT
31 S Main St,
Dayton, OH 45402-2070
Ph: (937) 860-1038 |
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