1528248531 NPI number — MR. TOMMY MCGOLDRICK LMHC

Table of content: MR. TOMMY MCGOLDRICK LMHC (NPI 1528248531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528248531 NPI number — MR. TOMMY MCGOLDRICK LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGOLDRICK
Provider First Name:
TOMMY
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528248531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6621 DONIPHAN DR STE G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANUTILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79835-5005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-877-5100
Provider Business Mailing Address Fax Number:
915-877-5107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6621 DONIPHAN DR STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANUTILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79835-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-877-5100
Provider Business Practice Location Address Fax Number:
915-877-5107
Provider Enumeration Date:
11/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0108901 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: VNM30451NI , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com