Provider Demographics
NPI:1003997354
Name:DAVID, SUZANNE GOODMAN (MED)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:GOODMAN
Last Name:DAVID
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12820 HILLCREST RD
Mailing Address - Street 2:C124
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1526
Mailing Address - Country:US
Mailing Address - Phone:972-728-1566
Mailing Address - Fax:972-728-1567
Practice Address - Street 1:12820 HILLCREST RD
Practice Address - Street 2:C124
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1526
Practice Address - Country:US
Practice Address - Phone:972-728-1566
Practice Address - Fax:972-728-1567
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16470101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455448Medicaid