Provider Demographics
NPI:1497067169
Name:MARK P. GOLDMAN, P.C.
Entity Type:Organization
Organization Name:MARK P. GOLDMAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:830-895-1840
Mailing Address - Street 1:PO BOX 291993
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-1993
Mailing Address - Country:US
Mailing Address - Phone:830-895-1840
Mailing Address - Fax:830-896-9340
Practice Address - Street 1:222 SIDNEY BAKER S
Practice Address - Street 2:SUITE 500
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5994
Practice Address - Country:US
Practice Address - Phone:830-895-1840
Practice Address - Fax:830-896-9340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22476103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty