Provider Demographics
NPI:1275867533
Name:GOODWIN, GLENDA RUTH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:RUTH
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:ALVORD
Mailing Address - State:TX
Mailing Address - Zip Code:76225-0488
Mailing Address - Country:US
Mailing Address - Phone:940-389-7675
Mailing Address - Fax:940-427-9771
Practice Address - Street 1:409 N SMYTHE ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-4826
Practice Address - Country:US
Practice Address - Phone:940-389-7675
Practice Address - Fax:940-427-9771
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17655101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17655OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS