Provider Demographics
NPI:1609650480
Name:MAYORAL-GOODWIN, MIRAKEL GRACE (LMSW)
Entity Type:Individual
Prefix:
First Name:MIRAKEL
Middle Name:GRACE
Last Name:MAYORAL-GOODWIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 BRAEWICK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-5819
Mailing Address - Country:US
Mailing Address - Phone:978-902-6715
Mailing Address - Fax:
Practice Address - Street 1:5959 WEST LOOP S STE 430
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2403
Practice Address - Country:US
Practice Address - Phone:713-660-0776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109069104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker