Provider Demographics
NPI:1467650358
Name:GOODSON, TINA L (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:L
Last Name:GOODSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2000 GRAVEL HILL ST
Mailing Address - Street 2:UNIT 203
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-6970
Mailing Address - Country:US
Mailing Address - Phone:702-538-8076
Mailing Address - Fax:
Practice Address - Street 1:2810 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 78
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1921
Practice Address - Country:US
Practice Address - Phone:702-968-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL17782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry