Provider Demographics
NPI:1750830493
Name:C. DRAVEN GODWIN PSYCHOLOGY
Entity Type:Organization
Organization Name:C. DRAVEN GODWIN PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:DRAVEN
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, PHD
Authorized Official - Phone:323-610-9107
Mailing Address - Street 1:4370 TUJUNGA AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2753
Mailing Address - Country:US
Mailing Address - Phone:310-795-4428
Mailing Address - Fax:818-396-3173
Practice Address - Street 1:4370 TUJUNGA AVE STE 150
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2753
Practice Address - Country:US
Practice Address - Phone:310-795-4428
Practice Address - Fax:818-396-3173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21516103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty