Healthcare Provider Details

I. General information

NPI: 1376450296
Provider Name (Legal Business Name): GOODWIN COUNSELING AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MONTGOMERY PL
DECATUR IL
62522-2654
US

IV. Provider business mailing address

90 MONTGOMERY PL
DECATUR IL
62522-2654
US

V. Phone/Fax

Practice location:
  • Phone: 262-309-5821
  • Fax:
Mailing address:
  • Phone: 262-309-5821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LESLEY GOODWIN
Title or Position: MANAGER/COUNSELOR
Credential: LCPC
Phone: 262-309-5821