Provider Demographics
NPI:1407381635
Name:GODOY, KARLA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:
Last Name:GODOY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:KARLA
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:435 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-5816
Mailing Address - Country:US
Mailing Address - Phone:951-420-8620
Mailing Address - Fax:
Practice Address - Street 1:2677 N MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6663
Practice Address - Country:US
Practice Address - Phone:714-274-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142521106H00000X
CA176472106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106802OtherLICENSE NUMBER