Provider Demographics
NPI:1972613271
Name:GOODWIN, RUSSELL J (LPC, LICDC)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:J
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:LPC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23240 CHAGRIN BLVD.
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5404
Mailing Address - Country:US
Mailing Address - Phone:216-292-6007
Mailing Address - Fax:216-292-7352
Practice Address - Street 1:23240 CHAGRIN BLVD.
Practice Address - Street 2:SUITE 500
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5404
Practice Address - Country:US
Practice Address - Phone:216-292-6007
Practice Address - Fax:216-292-7352
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH83884101YA0400X
OHC005220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional