Provider Demographics
NPI:1114582582
Name:GODHWANI, TARA (MS, NCC, LPC-I)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:GODHWANI
Suffix:
Gender:F
Credentials:MS, NCC, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 BRIARGROVE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6000
Mailing Address - Country:US
Mailing Address - Phone:281-704-0112
Mailing Address - Fax:
Practice Address - Street 1:6803 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1308
Practice Address - Country:US
Practice Address - Phone:214-363-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81819101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional