Provider Demographics
NPI:1083245641
Name:PHILLIPS-GOODWIN, LINDSAY (CDCA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:PHILLIPS-GOODWIN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HARTSHORN DR
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-2601
Mailing Address - Country:US
Mailing Address - Phone:216-527-3802
Mailing Address - Fax:
Practice Address - Street 1:3793 GREEN RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5705
Practice Address - Country:US
Practice Address - Phone:216-232-5302
Practice Address - Fax:216-393-3690
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
OHCDCA.178236101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0429697Medicaid