Provider Demographics
NPI:1073004057
Name:GOLDSTEIN, PHILLIP MARK (QMHP)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:MARK
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 BRAESRIDGE DR APT 622
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2129
Mailing Address - Country:US
Mailing Address - Phone:832-782-2656
Mailing Address - Fax:
Practice Address - Street 1:11100 BRAESRIDGE DR APT 622
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2129
Practice Address - Country:US
Practice Address - Phone:832-782-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator