Provider Demographics
NPI:1558966127
Name:GOUDARZI, NEGHIN
Entity Type:Individual
Prefix:
First Name:NEGHIN
Middle Name:
Last Name:GOUDARZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 N CENTRAL EXPY STE 1820
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-0946
Mailing Address - Country:US
Mailing Address - Phone:214-363-2345
Mailing Address - Fax:469-716-5053
Practice Address - Street 1:5910 N CENTRAL EXPY STE 1820
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-0946
Practice Address - Country:US
Practice Address - Phone:214-363-2345
Practice Address - Fax:469-716-5053
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX88343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician