Logan James Goolsby I, MA, BA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

3365 Wynn Rd
Las Vegas, NV 89102-8210

Phone

(702) 331-3845

NPI assigned

Jan 2, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts, Master of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1577923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577923200000",
    "number": "1073152419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2408 MOUNTAIN RAIL DR",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890843128",
            "telephone_number": "951-285-0893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3365 WYNN RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891028210",
            "telephone_number": "702-331-3845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOOLSBY",
        "first_name": "LOGAN",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "name_suffix": "I",
        "credential": "MA, BA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-02",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103K00000X",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.rdljg5546.com",
            "affiliation": "N",
            "endpointDescription": "movie",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3365 Wynn Rd",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891028210",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.rdljg5546.com",
            "affiliation": "N",
            "endpointDescription": "movie",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3365 Wynn Rd",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891028210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nelson Renee Goodwin
• Robert Goodwin
• Shelley Goodwin
• T'Shyna Goodwin
• Philip Goodwine
• Omni Alexis Goolsby
• Haik Goomroyan
• Akila Vinudha Goonesinghe, MD
• Sameer Gopalani, MD
• Jennifer Saquing Gopeng, MD

• Behavior Analyst in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Behavior Analyst in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.