Provider Demographics
NPI:1417328287
Name:GODES, NATALYA (PSYD)
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:GODES
Suffix:
Gender:F
Credentials:PSYD
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 18228
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-8228
Mailing Address - Country:US
Mailing Address - Phone:949-722-7118
Mailing Address - Fax:949-390-6519
Practice Address - Street 1:17782 COWAN
Practice Address - Street 2:SUITE A
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6030
Practice Address - Country:US
Practice Address - Phone:949-722-7118
Practice Address - Fax:949-390-6519
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY27363OtherSTATE LICENSE