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General NPI Number Information
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NPI Number | 1750830493
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Entity Type | Organization
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Legal Business Name | C. DRAVEN GODWIN PSYCHOLOGY
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 4370 TUJUNGA AVE STE 150
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City | STUDIO CITY
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State | CA
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Zip | 91604-2753
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Country | US
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Telephone | 310-795-4428
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Fax | 818-396-3173
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Provider Business Mailing Address
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Address Line | 4370 TUJUNGA AVE STE 150
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City | STUDIO CITY
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State | CA
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Zip | 91604-2753
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Country | US
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Telephone | 310-795-4428
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Fax | 818-396-3173
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. CHRISTIAN DRAVEN GODWIN
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Credential | M.ED., PH.D.
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Telephone | 323-610-9107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY21516
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License Number State | CA
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