Healthcare Provider Details

I. General information

NPI: 1023342805
Provider Name (Legal Business Name): DON M GOODMAN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HODENCAMP RD STE 103
THOUSAND OAKS CA
91360-5833
US

IV. Provider business mailing address

123 HODENCAMP RD STE 103
THOUSAND OAKS CA
91360-5833
US

V. Phone/Fax

Practice location:
  • Phone: 818-917-4524
  • Fax: 800-878-7720
Mailing address:
  • Phone: 818-917-4524
  • Fax: 805-449-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 22613
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY 22613
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY 22613
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 22613
License Number StateCA

VIII. Authorized Official

Name: DR. DONALD MITCHELL GOODMAN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 818-917-4524