MEDICARE: KEVIN GOODWIN SR. M.A., APCC, PPS

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	APCC16194	CA

General Provider Information

NPI Number	:	1396604740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN GOODWIN SR. M.A., APCC, PPS

Provider Business Mailing Address
First Line	:	2822 CHAUNCY CIR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95209-1615
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 CARPENTER RD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95206-3809
Country	:	US
Telephone Number	:	209-933-7260
Fax Number	:

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

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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