Provider Demographics
NPI:1588216352
Name:GOODWIN, MATTHEW (MA, LMHCA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MOUNDS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-6322
Mailing Address - Country:US
Mailing Address - Phone:206-369-1070
Mailing Address - Fax:
Practice Address - Street 1:56 MOUNDS BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6322
Practice Address - Country:US
Practice Address - Phone:206-369-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60946267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health