Provider Demographics
NPI:1386973196
Name:GODAT, TRUDY A (MS, LPC, CADC)
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:A
Last Name:GODAT
Suffix:
Gender:F
Credentials:MS, LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 NW HAWTHORNE AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2929
Mailing Address - Country:US
Mailing Address - Phone:541-977-4023
Mailing Address - Fax:
Practice Address - Street 1:131 NW HAWTHORNE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2929
Practice Address - Country:US
Practice Address - Phone:541-977-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional