Provider Demographics
NPI:1962967190
Name:GOODWIN, RACHEL ANNE (LPC, LCPC, LCDC)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:ANNE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LPC, LCPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BOURLAND RD APT 627
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3538
Mailing Address - Country:US
Mailing Address - Phone:817-706-8580
Mailing Address - Fax:
Practice Address - Street 1:304 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3325
Practice Address - Country:US
Practice Address - Phone:832-377-9618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78662101Y00000X, 101YP2500X
TX14333101YA0400X
IL180012929101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)