Provider Demographics
NPI:1629336268
Name:GOAD, JASON ERIC (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ERIC
Last Name:GOAD
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12421 LOWDEN LN
Mailing Address - Street 2:A
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-3621
Mailing Address - Country:US
Mailing Address - Phone:512-820-7081
Mailing Address - Fax:
Practice Address - Street 1:1715 FM 1626
Practice Address - Street 2:103
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-3553
Practice Address - Country:US
Practice Address - Phone:512-820-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional