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General NPI Number Information
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NPI Number | 1780047886
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Entity Type | Individual
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Provider Name | AUDREY S GODDARD LMHC
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Gender | Female
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 4401 W WESTERN AVE STE C
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City | SOUTH BEND
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State | IN
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Zip | 46619-2645
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Country | US
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Telephone | 574-725-7006
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Fax | 574-807-9614
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Provider Business Mailing Address
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Address Line | 59877 MIDDLEBORO ST
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City | SOUTH BEND
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State | IN
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Zip | 46614-3625
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Country | US
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Telephone |
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Fax |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39003682A
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License Number State | IN
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