MEDICARE: MS. MICHELLE LYNN GODWIN MA 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	101YP2500X	Professional Counselor	CO-4870	CO

General Provider Information

NPI Number	:	1578667622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE LYNN GODWIN MA LPC

Provider Business Mailing Address
First Line	:	12917 LAFAYETTE ST UNIT A
Second Line	:
City	:	THORNTON
State	:	CO
Zip	:	80241-3955
Country	:	US
Telephone Number	:	720-542-3134
Fax Number	:

Provider Business Practice Location Address
First Line	:	11059 E BETHANY DR
Second Line	:	SUITE 200
City	:	AURORA
State	:	CO
Zip	:	80014-2622
Country	:	US
Telephone Number	:	303-617-2311
Fax Number	:

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	08/19/2009

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