Provider Demographics
NPI:1194145995
Name:GODWIN, MICHELLE (MS, MED, LPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MS, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 DOGWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76118-6430
Mailing Address - Country:US
Mailing Address - Phone:214-783-4236
Mailing Address - Fax:
Practice Address - Street 1:2801 DOGWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76118-6430
Practice Address - Country:US
Practice Address - Phone:214-783-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health