Provider Demographics
NPI:1740419134
Name:GOODWIN, MARLA ANN
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:ANN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 S VEGAS
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-7280
Mailing Address - Country:US
Mailing Address - Phone:480-338-8793
Mailing Address - Fax:
Practice Address - Street 1:924 S VEGAS
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-7280
Practice Address - Country:US
Practice Address - Phone:480-338-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health