Provider Demographics
NPI:1518163781
Name:GOODWIN, TIA (MS, LMHP, PLADC)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MS, LMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7436 POTTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1506
Mailing Address - Country:US
Mailing Address - Phone:402-714-2047
Mailing Address - Fax:402-991-7260
Practice Address - Street 1:7436 POTTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1506
Practice Address - Country:US
Practice Address - Phone:402-714-2047
Practice Address - Fax:402-991-7260
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health