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General NPI Number Information
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NPI Number | 1639992597
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Entity Type | Individual
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Provider Name | KATELYN GOODALL PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 100 DEERFIELD PRESERVE BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5966
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Country | US
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Telephone | 904-829-0814
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Fax |
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Provider Business Mailing Address
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Address Line | 28 WHIRLAWAY DR
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City | PALM COAST
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State | FL
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Zip | 32164-7260
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Country | US
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Telephone | 361-205-0642
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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