Provider Demographics
NPI:1255060117
Name:GOODWIN, PETER WILLIAM (PSYD)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:WILLIAM
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 E ORCHARD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1726
Mailing Address - Country:US
Mailing Address - Phone:720-868-5829
Mailing Address - Fax:
Practice Address - Street 1:3011 S GLENCOE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6805
Practice Address - Country:US
Practice Address - Phone:312-934-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0006241103TC0700X
COLPC.0017933101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty