Provider Demographics
NPI:1275811390
Name:GODINEZ, ALEX (MA)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:GODINEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6340 AMERICANA DR
Mailing Address - Street 2:UNIT 622
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2255
Mailing Address - Country:US
Mailing Address - Phone:630-306-1167
Mailing Address - Fax:
Practice Address - Street 1:222 E WILLOW AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5426
Practice Address - Country:US
Practice Address - Phone:630-784-4866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health