Provider Demographics
NPI:1497388409
Name:GODWIN, ARRIE MATTHEW (LPC)
Entity Type:Individual
Prefix:MR
First Name:ARRIE
Middle Name:MATTHEW
Last Name:GODWIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 MICHAELIS UNIT B
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-4394
Mailing Address - Country:US
Mailing Address - Phone:512-757-2037
Mailing Address - Fax:
Practice Address - Street 1:2003 MEDICAL PKWY STE C
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7554
Practice Address - Country:US
Practice Address - Phone:512-643-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty