Provider Demographics
NPI:1821221334
Name:GOBER, MARY ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:GOBER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 N PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-3138
Mailing Address - Country:US
Mailing Address - Phone:214-412-9587
Mailing Address - Fax:
Practice Address - Street 1:1131 ROCKINGHAM DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4354
Practice Address - Country:US
Practice Address - Phone:214-412-9587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018114-1103T00000X
TX34468103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist