Provider Demographics
NPI:1871704635
Name:GOODSON, PHYLLIS (MA, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:GOODSON
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9681 W LOOP 1604 N
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5303
Mailing Address - Country:US
Mailing Address - Phone:210-688-9434
Mailing Address - Fax:210-688-3859
Practice Address - Street 1:9681 W LOOP 1604 N
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5303
Practice Address - Country:US
Practice Address - Phone:210-688-9434
Practice Address - Fax:210-688-3859
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14170101YM0800X
TX4728106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist