Provider Demographics
NPI:1003534587
Name:GOODSELL, DIANA (EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:GOODSELL
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 VALUE RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5313
Mailing Address - Country:US
Mailing Address - Phone:702-684-1741
Mailing Address - Fax:
Practice Address - Street 1:731 VALUE RIDGE AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5313
Practice Address - Country:US
Practice Address - Phone:702-684-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM412855103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty