Provider Demographics
NPI:1801936737
Name:GOLDSON, JASON ELLIOTT (BA)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ELLIOTT
Last Name:GOLDSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4569 E. DEARING RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-6508
Mailing Address - Country:US
Mailing Address - Phone:901-457-1921
Mailing Address - Fax:
Practice Address - Street 1:5515 SHELBY OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7316
Practice Address - Country:US
Practice Address - Phone:901-252-7707
Practice Address - Fax:901-252-7620
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health