Healthcare Provider Details

I. General information

NPI: 1003386871
Provider Name (Legal Business Name): GOODWIN HEALTH CAFE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 N WALL ST STE 100
SPOKANE WA
99205-6435
US

IV. Provider business mailing address

5625 N WALL ST STE 100
SPOKANE WA
99205-6435
US

V. Phone/Fax

Practice location:
  • Phone: 509-415-3507
  • Fax:
Mailing address:
  • Phone: 509-415-3507
  • Fax: 857-270-7251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARY MARGARET ALLEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-415-3507