Provider Demographics
NPI:1295300028
Name:GODBY, MICHAEL PETER
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PETER
Last Name:GODBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HAMES RD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-0200
Mailing Address - Country:US
Mailing Address - Phone:831-234-2150
Mailing Address - Fax:
Practice Address - Street 1:220 HAMES RD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-0200
Practice Address - Country:US
Practice Address - Phone:831-234-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty