Provider Demographics
NPI:1255213864
Name:MIKE GODBY THERAPY
Entity type:Organization
Organization Name:MIKE GODBY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JON
Authorized Official - Last Name:GODBY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:805-501-5162
Mailing Address - Street 1:5476 SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-5031
Mailing Address - Country:US
Mailing Address - Phone:805-501-5162
Mailing Address - Fax:
Practice Address - Street 1:5476 SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-5031
Practice Address - Country:US
Practice Address - Phone:805-501-5162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)