De'Rese Zyire Gooden, NCC, LCMHC, CCHT

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

License

C.1700611 Issued in OH

Practice address

31 S Main St
Dayton, OH 45402-2070

Phone

(937) 860-1038

Fax

(270) 203-0587

NPI assigned

Aug 3, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Reserevelations, LLC

  • Voluntary or Charitable Agency
  • Dayton, OH
  • NPI 1083326706
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736035200000",
    "number": "1265957914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 S MAIN ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454022070",
            "telephone_number": "937-860-1038",
            "fax_number": "270-203-0587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 S MAIN ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454022070",
            "telephone_number": "937-860-1038",
            "fax_number": "270-203-0587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODEN",
        "first_name": "DE'RESE",
        "middle_name": "ZYIRE",
        "name_prefix": "Mr.",
        "credential": "NCC, LCMHC, CCHT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-03",
        "last_updated": "2025-01-05",
        "certification_date": "2025-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "C.1700611",
            "primary": false
        },
        {
            "code": "102L00000X",
            "taxonomy_group": "",
            "desc": "Psychoanalyst",
            "state": "OH",
            "license": "11725",
            "primary": false
        },
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "OH",
            "license": "C.1700611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0307155",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Good Samaritian Hospital
• Conrad Goode V
• Roger Lee Goode
• Tameka Goode
• David Joseph Gooden, DO
• Scott Goodhart, DC
• Goodhelp Home Care Services
• Goodhelp Home Care Services
• Goodhelp Home Care Services
• Jennifer Goodin, APRN

• Prevention Professional in Dayton, OH
• Providers in Dayton, OH by specialty
• Prevention Professional in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.