STEPHANIE DIANE GOLDMAN, BHR — NPI 1104113083 (Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Rehabilitation in WATONGA, OK)

CMS-1500 Box 24J / 33a • NPI

1104113083

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

103TR0400X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Rehabilitation

Box 32 Service Location & ZIP+4

403 N CLARENCE NASH BLVD, WATONGA, OK, 73772-3636

✓ 9-Digit EDI 837 ZIP+4 (73772-3636)

Practice Phone & Referral Fax

(580) 623-5433

Fax: (580) 623-2409

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104113083 (STEPHANIE DIANE GOLDMAN, BHR) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104113083` (NPI-1 Individual Practitioner)
Provider / Legal Name	STEPHANIE DIANE GOLDMAN, BHR
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Rehabilitation NUCC Code: `103TR0400X` (Psychologist, Rehabilitation)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	403 N CLARENCE NASH BLVD, WATONGA, OK, 73772-3636
Practice Telephone / Fax	Tel: (580) 623-5433 \| Fax: (580) 623-2409
Administrative Mailing Address	1500 E PROCTOR AVE APT 2, WEATHERFORD, OK, 73096-4239
Enumeration & Last Sync	Enumerated: 2011-06-29 \| CMS Record Updated: 2011-06-29

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

403 N CLARENCE NASH BLVD, WATONGA, OK, 73772-3636

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Plain-English Taxonomy & CMS Crosswalk (103TR0400X)

What Does Taxonomy Code 103TR0400X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103TR0400X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Rehabilitation"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist, Rehabilitation for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (STEPHANIE DIANE GOLDMAN, BHR)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`103TR0400X` — Psychologist, Rehabilitation Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Rehabilitation	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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STEPHANIE DIANE GOLDMAN, BHR (NPI #1104113083)