Basic Information
| Provider Information | |||||||||
| NPI: | 1558663021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOODIN | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PH. D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GOODIN | ||||||||
| OtherFirstName: | TINA | ||||||||
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| OtherCredential: | PH..D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 600 SANDTREE DR | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334031597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613011464 | ||||||||
| FaxNumber: | 5618289272 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 JUPITER LAKES BLVD STE 302A | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613011464 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2010 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY8096 | FL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.