Provider Demographics
NPI:1316334808
Name:SONG GODWIN COUNSELING
Entity type:Organization
Organization Name:SONG GODWIN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:CAC III
Authorized Official - Phone:720-934-1302
Mailing Address - Street 1:7061 S UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1532
Mailing Address - Country:US
Mailing Address - Phone:720-934-1302
Mailing Address - Fax:720-283-4256
Practice Address - Street 1:7061 S UNIVERSITY BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1532
Practice Address - Country:US
Practice Address - Phone:720-934-1302
Practice Address - Fax:720-283-4256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004599101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty