Provider Demographics
NPI:1972238525
Name:GODWIN, KRISTIN EVA (CMHC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:EVA
Last Name:GODWIN
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 HUNT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-6103
Mailing Address - Country:US
Mailing Address - Phone:435-210-8725
Mailing Address - Fax:
Practice Address - Street 1:1513 HUNT CREEK DR
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-6103
Practice Address - Country:US
Practice Address - Phone:435-210-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11479117-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11479117-6004OtherSTATE LICENSE