Provider Demographics
NPI:1386879856
Name:GODSEY, MICHAELA D (LMHC, SUDP)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:D
Last Name:GODSEY
Suffix:
Gender:F
Credentials:LMHC, SUDP
Other - Prefix:MS
Other - First Name:MICHAELA
Other - Middle Name:D
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2569
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98213-0569
Mailing Address - Country:US
Mailing Address - Phone:425-493-5816
Mailing Address - Fax:425-493-5801
Practice Address - Street 1:25959 COMMUNITY PLAZA WAY
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-9721
Practice Address - Country:US
Practice Address - Phone:360-854-7067
Practice Address - Fax:360-854-7060
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA60100253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60815972OtherLICENSED MENTAL HEALTH THERAPIST
WACP60366824OtherSUBSTANCE USE DISORDER PROFESSIONAL