Provider Demographics
NPI:1275546848
Name:GODWIN, BRENDA LEE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEE
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-2559
Mailing Address - Country:US
Mailing Address - Phone:405-402-8323
Mailing Address - Fax:
Practice Address - Street 1:207 E F ST
Practice Address - Street 2:
Practice Address - City:OKEENE
Practice Address - State:OK
Practice Address - Zip Code:73763-9441
Practice Address - Country:US
Practice Address - Phone:580-822-4332
Practice Address - Fax:580-822-4378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200463070BMedicaid