Provider Demographics
NPI:1609666858
Name:GOODWIN, MELANIE M (CAS, CADC)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:M
Last Name:GOODWIN
Suffix:
Gender:
Credentials:CAS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N TOMAHAWK ISLAND DR APT 139
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-7813
Mailing Address - Country:US
Mailing Address - Phone:720-758-0391
Mailing Address - Fax:
Practice Address - Street 1:222 1/2 F ST STE 12
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2141
Practice Address - Country:US
Practice Address - Phone:720-758-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACA-0008255101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)