Provider Demographics
NPI:1316285406
Name:GOODWIN, RAQUEL TOVAR I (MA, IMFT)
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:TOVAR
Last Name:GOODWIN
Suffix:I
Gender:F
Credentials:MA, IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 S COAST DR
Mailing Address - Street 2:#202
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1534
Mailing Address - Country:US
Mailing Address - Phone:949-515-5440
Mailing Address - Fax:
Practice Address - Street 1:1503 S COAST DR
Practice Address - Street 2:#202
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1534
Practice Address - Country:US
Practice Address - Phone:949-515-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health