Provider Demographics
NPI:1134965098
Name:GODSHALL, TIMOTHY PAUL (MA, RMHCI)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PAUL
Last Name:GODSHALL
Suffix:
Gender:M
Credentials:MA, RMHCI
Other - Prefix:MR
Other - First Name:TIM
Other - Middle Name:PAUL
Other - Last Name:GODSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, RMHCI
Mailing Address - Street 1:2355 STATE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4541
Mailing Address - Country:US
Mailing Address - Phone:813-727-5545
Mailing Address - Fax:
Practice Address - Street 1:2355 STATE ST STE 101
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4541
Practice Address - Country:US
Practice Address - Phone:813-727-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24520101YM0800X
ORR9619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health