MEDICARE: MICHELLE GODWIN M.S., M.ED., LPC

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	101YM0800X	Mental Health Counselor	67051	TX

General Provider Information

NPI Number	:	1194145995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE GODWIN M.S., M.ED., LPC

Provider Business Mailing Address
First Line	:	2801 DOGWOOD PARK DR
Second Line	:
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76118-6430
Country	:	US
Telephone Number	:	214-783-4236
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 DOGWOOD PARK DR
Second Line	:
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76118-6430
Country	:	US
Telephone Number	:	214-783-4236
Fax Number	:

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

Provider Enumeration Date	:	04/18/2014
Last Update Date	:	04/18/2014

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