Healthcare Provider Details

I. General information

NPI: 1083870570
Provider Name (Legal Business Name): AMY GOODSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BLACK GOLD BLVD ARH BARIATRIC SERVICES, SUITE 102
HAZARD KY
41701-2603
US

IV. Provider business mailing address

102 MEDICAL CENTER DR ARH PSYCHIATRIC CENTER
HAZARD KY
41701-9421
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1331
  • Fax: 606-439-6629
Mailing address:
  • Phone: 606-439-6819
  • Fax: 606-439-6629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1420
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: