Provider Demographics
NPI:1790893691
Name:GOODWIN-HANSON, CARLYNE A (MFT)
Entity Type:Individual
Prefix:MS
First Name:CARLYNE
Middle Name:A
Last Name:GOODWIN-HANSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13399 MIDDLE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924
Mailing Address - Country:US
Mailing Address - Phone:831-277-6411
Mailing Address - Fax:831-659-2080
Practice Address - Street 1:335 EL DORADO
Practice Address - Street 2:#7
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-277-6411
Practice Address - Fax:831-659-2080
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21065106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist