Individual
DR. GARY NEAL GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
11110 N TATUM BLVD, SUITE 103, PHOENIX, AZ 85028-1607
(602) 432-0800
(623) 516-0637
Mailing address
11110 N TATUM BLVD, 103, PHOENIX, AZ 85028-1607
(602) 432-0800
(602) 443-0401
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3196
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
451352
—
AZ
Enumeration date
08/25/2005
Last updated
12/19/2014
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