Healthcare Provider Details

I. General information

NPI: 1508703349
Provider Name (Legal Business Name): JILL MARIE GOODWIN LMFT, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E COLORADO BLVD STE 180&2ND
PASADENA CA
91101-6143
US

IV. Provider business mailing address

680 E COLORADO BLVD STE 180&2ND
PASADENA CA
91101-6143
US

V. Phone/Fax

Practice location:
  • Phone: 302-281-4679
  • Fax:
Mailing address:
  • Phone: 302-281-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT45038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: