Healthcare Provider Details

I. General information

NPI: 1750296034
Provider Name (Legal Business Name): BONNI G GOODWIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 N DONALD AVE
BETHANY OK
73008-2724
US

IV. Provider business mailing address

4218 N DONALD AVE
BETHANY OK
73008-2724
US

V. Phone/Fax

Practice location:
  • Phone: 405-548-4686
  • Fax:
Mailing address:
  • Phone: 405-548-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6072
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: