{
"Npi": {
"NPI": "1700909645",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GOODWIN",
"FirstName": "JEAN",
"MiddleName": "M.",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4925 FORT CROCKETT BLVD",
"SecondLineMailingAddress": "SUITE 510",
"MailingAddressCityName": "GALVESTON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77551-6003",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "409-762-1101",
"MailingAddressFaxNumber": "409-762-1163",
"FirstLinePracticeLocationAddress": "4925 FORT CROCKETT BLVD",
"SecondLinePracticeLocationAddress": "SUITE 510",
"PracticeLocationAddressCityName": "GALVESTON",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77551-6003",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "409-762-1101",
"PracticeLocationAddressFaxNumber": "409-762-1163",
"EnumerationDate": "04/07/2007",
"LastUpdateDate": "09/11/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "102L00000X",
"TaxonomyName": "Psychoanalyst",
"LicenseNumber": "J3945",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "2084P0015X",
"TaxonomyName": "Psychosomatic Medicine Physician",
"LicenseNumber": "J3945",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}