MEDICARE: DR. CAROLYN B GOLDSMITH EDD LPC-S LMFT-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	9603	TX
2	101Y00000X	Counselor	703	TX

General Provider Information

NPI Number	:	1306854161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN B GOLDSMITH EDD LPC-S LMFT-S

Provider Business Mailing Address
First Line	:	6410 SOUTHWEST BLVD
Second Line	:	SUITE 230
City	:	FORT WORTH
State	:	TX
Zip	:	76109
Country	:	US
Telephone Number	:	817-292-8500
Fax Number	:	817-370-1068

Provider Business Practice Location Address
First Line	:	6410 SOUTHWEST BLVD
Second Line	:	SUITE 230
City	:	FORT WORTH
State	:	TX
Zip	:	76109
Country	:	US
Telephone Number	:	817-292-8500
Fax Number	:	817-370-1068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	04/11/2019

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