Provider Demographics
NPI:1578645297
Name:DAN GOODKIND PHD PC
Entity Type:Organization
Organization Name:DAN GOODKIND PHD PC
Other - Org Name:ASHLEY FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOODKIND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:435-781-8000
Mailing Address - Street 1:38 E 100 N
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2122
Mailing Address - Country:US
Mailing Address - Phone:435-781-8000
Mailing Address - Fax:435-781-8001
Practice Address - Street 1:38 E 100 N
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2122
Practice Address - Country:US
Practice Address - Phone:435-781-8000
Practice Address - Fax:435-781-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ46407Medicare UPIN