Healthcare Provider Details

I. General information

NPI: 1912825712
Provider Name (Legal Business Name): GOODWIN COUNSELING & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 NW ELM AVE
REDMOND OR
97756-1600
US

IV. Provider business mailing address

527 NW ELM AVE SUITE 3 #159
REDMOND OR
97756
US

V. Phone/Fax

Practice location:
  • Phone: 541-504-2112
  • Fax:
Mailing address:
  • Phone: 541-316-0186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLY ROSS GOODWIN
Title or Position: OWNER
Credential: LCSW
Phone: 541-316-0186