Provider Demographics
NPI:1619011038
Name:GOODWIN, BYROM ODELL SR (EDS, LPC)
Entity Type:Individual
Prefix:MR
First Name:BYROM
Middle Name:ODELL
Last Name:GOODWIN
Suffix:SR
Gender:M
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NOBLE DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1609
Mailing Address - Country:US
Mailing Address - Phone:256-533-1799
Mailing Address - Fax:256-533-2506
Practice Address - Street 1:333 FRANKLIN ST SE STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4264
Practice Address - Country:US
Practice Address - Phone:256-533-1799
Practice Address - Fax:256-533-2506
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL205101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional