Provider Demographics
NPI:1255001798
Name:GOODSON, AARON TIMMONS (PHD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:TIMMONS
Last Name:GOODSON
Suffix:
Gender:M
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:PO BOX 5327
Mailing Address - Street 2:
Mailing Address - City:MISSISSIPPI STATE
Mailing Address - State:MS
Mailing Address - Zip Code:39762-5327
Mailing Address - Country:US
Mailing Address - Phone:662-341-0772
Mailing Address - Fax:662-325-6775
Practice Address - Street 1:235 LAKEVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:MISSISSIPPI STATE
Practice Address - State:MS
Practice Address - Zip Code:39762
Practice Address - Country:US
Practice Address - Phone:662-341-0772
Practice Address - Fax:662-325-6775
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health