Basic Information
| Provider Information | |||||||||
| NPI: | 1316285406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOODWIN | ||||||||
| FirstName: | RAQUEL | ||||||||
| MiddleName: | TOVAR | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | I | ||||||||
| Credential: | M.A., IMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1503 S COAST DR | ||||||||
| Address2: | #202 | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926261534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495155440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1503 S COAST DR | ||||||||
| Address2: | #202 | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926261534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495155440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2013 | ||||||||
| LastUpdateDate: | 01/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.