Provider Demographics
NPI:1245866615
Name:GODDARD, ERIN NICOLE (BCBA)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:NICOLE
Last Name:GODDARD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 INTERSTATE 45 N STE 110
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2185
Mailing Address - Country:US
Mailing Address - Phone:832-263-8955
Mailing Address - Fax:
Practice Address - Street 1:3251 INTERSTATE 45 N STE 110
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2185
Practice Address - Country:US
Practice Address - Phone:832-263-8955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty