Provider Demographics
NPI:1811441959
Name:GODSEY, ANTHONY (MA)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:GODSEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601951
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95860-1951
Mailing Address - Country:US
Mailing Address - Phone:916-316-7627
Mailing Address - Fax:
Practice Address - Street 1:32 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685-4231
Practice Address - Country:US
Practice Address - Phone:916-316-7627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 62869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist