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General NPI Number Information
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NPI Number | 1841892163
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Entity Type | Individual
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Provider Name | CORY GOULDMAN MS, LPC
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Gender | Male
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 504 N HEWITT DR STE 2
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City | HEWITT
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State | TX
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Zip | 76643-3173
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Country | US
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Telephone | 254-600-9896
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Fax |
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Provider Business Mailing Address
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Address Line | 115 NEW ACRES DR
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City | HEWITT
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State | TX
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Zip | 76643-3228
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Country | US
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Telephone | 254-600-9896
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 80831
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License Number State | TX
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