Healthcare Provider Details

I. General information

NPI: 1598845844
Provider Name (Legal Business Name): HEATHER S GOODMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1977 BUTLER BLVD STE 400
HOUSTON TX
77030-4101
US

IV. Provider business mailing address

1977 BUTLER BLVD STE 400
HOUSTON TX
77030-4101
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-3944
  • Fax: 713-798-3465
Mailing address:
  • Phone: 713-798-3944
  • Fax: 713-798-3465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberJ9506
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: