=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376450296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOODWIN COUNSELING AND WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2026
-----------------------------------------------------
Last Update Date | 08/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 90 MONTGOMERY PL
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62522-2654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-309-5821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 90 MONTGOMERY PL
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62522-2654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-309-5821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/COUNSELOR
-----------------------------------------------------
Name | ROBERT LESLEY GOODWIN
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 262-309-5821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------