Healthcare Provider Details

I. General information

NPI: 1073708590
Provider Name (Legal Business Name): AMY A GOODWIN LPC, CACIII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 LINCOLN AVE
STEAMBOAT SPRINGS CO
80487-5005
US

IV. Provider business mailing address

PO BOX 882917 810 LINCOLN AVE
STEAMBOAT SPRINGS CO
80488-2917
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-7637
  • Fax:
Mailing address:
  • Phone: 970-879-7637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6584
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5378
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: