MEDICARE: MR. LUCAS GOODWIN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	61663117	WA

General Provider Information

NPI Number	:	1144779794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUCAS GOODWIN PHD

Provider Business Mailing Address
First Line	:	688 CHUCKANUT HEIGHTS RD
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-8988
Country	:	US
Telephone Number	:	646-331-4262
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 N COMMERCIAL ST STE 415
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4437
Country	:	US
Telephone Number	:	360-712-3154
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	12/09/2025

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