Provider Demographics
NPI:1073708590
Name:GOODWIN, AMY A (LPC, CACIII)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:A
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LPC, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 882917
Mailing Address - Street 2:810 LINCOLN AVE
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80488-2917
Mailing Address - Country:US
Mailing Address - Phone:970-879-7637
Mailing Address - Fax:
Practice Address - Street 1:810 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-5005
Practice Address - Country:US
Practice Address - Phone:970-879-7637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6584101YA0400X
CO5378101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
5378OtherLICENSED PROFESSIONAL COUNSELOR