Provider Demographics
NPI:1063667137
Name:GOODRICH, THELMA JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:JEAN
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HOLCOMBE BLVD
Mailing Address - Street 2:1201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4222
Mailing Address - Country:US
Mailing Address - Phone:713-866-4876
Mailing Address - Fax:
Practice Address - Street 1:2001 HOLCOMBE BLVD
Practice Address - Street 2:1201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4222
Practice Address - Country:US
Practice Address - Phone:713-866-4876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLMFT004875-005397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXUPIN B1047707OtherBLUECROSSBLUE SHIELD TEXAS