Healthcare Provider Details

I. General information

NPI: 1336759497
Provider Name (Legal Business Name): HOPE MARIE GODFREY COUNSELOR TRAINEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4968 GLENWAY AVE STE 215
CINCINNATI OH
45238-3902
US

IV. Provider business mailing address

2621 VICTORY PKWY FL 1
CINCINNATI OH
45206-1754
US

V. Phone/Fax

Practice location:
  • Phone: 513-853-6575
  • Fax:
Mailing address:
  • Phone: 513-221-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2002548-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: