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General NPI Number Information
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NPI Number | 1275867533
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Entity Type | Individual
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Provider Name | GLENDA RUTH GOODWIN LPC
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Gender | Female
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 409 N SMYTHE ST
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City | BOWIE
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State | TX
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Zip | 76230-4826
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Country | US
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Telephone | 940-389-7675
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Fax | 940-427-9771
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Provider Business Mailing Address
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Address Line | PO BOX 488
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City | ALVORD
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State | TX
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Zip | 76225-0488
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Country | US
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Telephone | 940-389-7675
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Fax | 940-427-9771
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 17655
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License Number State | TX
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