Healthcare Provider Details

I. General information

NPI: 1851798623
Provider Name (Legal Business Name): REBECCA GODSILL DURBAHN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA HARTMAN GODSILL LCSW

II. Dates (important events)

Enumeration Date: 11/22/2014
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 TENNYSON ST
DENVER CO
80212-3029
US

IV. Provider business mailing address

2950 TENNYSON ST
DENVER CO
80212-3029
US

V. Phone/Fax

Practice location:
  • Phone: 720-855-3452
  • Fax: 303-433-9701
Mailing address:
  • Phone: 720-855-3452
  • Fax: 303-433-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1502
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: