Provider Demographics
NPI:1073832077
Name:BEIKIRCH-GODWIN, MARY ELISABETH (MA, LMHC, CAP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELISABETH
Last Name:BEIKIRCH-GODWIN
Suffix:
Gender:F
Credentials:MA, LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 S FLORIDA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2512
Mailing Address - Country:US
Mailing Address - Phone:863-640-2807
Mailing Address - Fax:863-510-5903
Practice Address - Street 1:5110 S FLORIDA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2512
Practice Address - Country:US
Practice Address - Phone:863-640-2807
Practice Address - Fax:863-510-5903
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8009101YM0800X, 101YP2500X, 101YA0400X, 101Y00000X
FL651278101YS0200X
FL4269101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor