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General NPI Number Information
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NPI Number | 1174630065
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Entity Type | Individual
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Provider Name | STEPHEN GREGG GODFREY PSYD,NCC,LMHC.
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 1313 S WASHINGTON AVE STE D
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City | TITUSVILLE
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State | FL
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Zip | 32780-4292
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Country | US
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Telephone | 321-567-4903
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Fax | 321-567-4904
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Provider Business Mailing Address
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Address Line | 1313 S WASHINGTON AVE STE D
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City | TITUSVILLE
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State | FL
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Zip | 32780-4292
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Country | US
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Telephone | 321-567-4903
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Fax | 321-567-4904
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMHC6545
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License Number State | FL
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