| Geriatric And Family Mental Health Services, Llc | |
|
11110 N Tatum Blvd 103 Phoenix AZ 85028-1607 | |
| (602) 432-0800 | |
| (602) 443-0401 |
| Full Name | Geriatric And Family Mental Health Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 11110 N Tatum Blvd, Phoenix, Arizona |
| Authorized Official Name and Position | Gary Neal Goodman (OWNER) |
| Authorized Official Contact | 6024320800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Geriatric And Family Mental Health Services, Llc 11110 N Tatum Blvd Suite 103 Phoenix AZ 85028-1607 Ph: (602) 432-0800 | Geriatric And Family Mental Health Services, Llc 11110 N Tatum Blvd 103 Phoenix AZ 85028-1607 Ph: (602) 432-0800 |
| NPI Number | 1679566624 |
|---|---|
| Provider Enumeration Date | 08/24/2005 |
| Last Update Date | 01/08/2015 |
| Medicare PECOS PAC ID | 9436144417 |
|---|---|
| Medicare Enrollment ID | O20040419000839 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679566624 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 3196 (Arizona) | Primary |
| Provider Name | Gary N Goodman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316930381 PECOS PAC ID: 2860487840 Enrollment ID: I20051010000342 |
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