Provider Demographics
NPI:1083758270
Name:GOODWIN, AMY CARLISLE (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CARLISLE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 ENFIELD RD
Mailing Address - Street 2:#213
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-3282
Mailing Address - Country:US
Mailing Address - Phone:512-457-8131
Mailing Address - Fax:
Practice Address - Street 1:2408 ENFIELD RD
Practice Address - Street 2:#213
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703
Practice Address - Country:US
Practice Address - Phone:512-457-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16193101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor