| Doctor Name: | RANDALL R GODWIN |
| NPI Number: | 1205160108 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.ED., LISAC |
| License Number: | LISAC-11869 |
| Business Practice Address: | 925 N Plaza Dr Apache Junction, AZ - 851204135 |
| Business Phone Number: | 4802444313 |
| Business Fax Number: | |
| Mailing Address: | Po Box 771, APACHE JUNCTION |
| State: | AZ |
| Postal Code: | 851174027 |
| Phone Number: | 4802444313 |
| Fax Number: | |
| NPI Enumeration Date: | 09/24/2009 |
| NPI Last Update Date: | 09/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LISAC-11869 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |