MEDICARE: MISS ELIZABETH L GODWIN MFT ASSOCIATE

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	ASSOCIATE # 58	AL

General Provider Information

NPI Number	:	1437347572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELIZABETH L GODWIN MFT ASSOCIATE

Provider Business Mailing Address
First Line	:	978 APPLETON RD
Second Line	:
City	:	CASTLEBERRY
State	:	AL
Zip	:	36432-5542
Country	:	US
Telephone Number	:	251-578-0017
Fax Number	:	251-578-2405

Provider Business Practice Location Address
First Line	:	101 PERRYMAN STREET HWY 31
Second Line	:	COMPASS ACADEMY
City	:	EVERGREEN
State	:	AL
Zip	:	36401
Country	:	US
Telephone Number	:	251-578-0017
Fax Number	:	251-578-2405

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

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	10/12/2007

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