Provider Demographics
NPI:1225401524
Name:GODLEY, CYNTHIA FAYE (MS THERAPIST)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:FAYE
Last Name:GODLEY
Suffix:
Gender:F
Credentials:MS THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 14TH AVE SE APT C112
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2203
Mailing Address - Country:US
Mailing Address - Phone:678-551-0509
Mailing Address - Fax:
Practice Address - Street 1:3800 14TH AVE SE APT C112
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2203
Practice Address - Country:US
Practice Address - Phone:678-551-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052356162101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health