Individual
MRS. FARA DIANE GOODWYN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., BCBA
Contact information
Practice address
1318 MEMORIAL DR, BRYAN, TX 77802-5215
(979) 776-2872
Mailing address
1413 ANGELINA CIR, COLLEGE STATION, TX 77840-4952
(979) 229-4815
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-10-7377
TX
Other
Enumeration date
03/28/2011
Last updated
03/28/2011
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