Provider Demographics
NPI:1558873927
Name:GODFREY, ALAN ROBERT (LMFT)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:ROBERT
Last Name:GODFREY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 CROW CANYON PL STE 140
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1339
Mailing Address - Country:US
Mailing Address - Phone:925-820-1467
Mailing Address - Fax:
Practice Address - Street 1:3180 CROW CANYON PL STE 140
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1339
Practice Address - Country:US
Practice Address - Phone:925-820-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health