Jason Hayes Goodwin, LCPC, CDAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC-3639 Issued in ID

Practice address

1417 N. 4TH St.
Coeur D'Alene, ID 83814

Phone

(208) 292-2188

Fax

(208) 292-2189

NPI assigned

Sep 20, 2006

Last updated

Aug 4, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2024 through Apr 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cultivation, LLC

  dba Cultivation Counseling

  • Community/Behavioral Health Agency
  • Coeur d'Alene, ID
  • NPI 1124466990
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312416000000",
    "number": "1174621627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 N. 4TH ST.",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-292-2188",
            "fax_number": "208-292-2189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 N. 4TH ST.",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-292-2188",
            "fax_number": "208-292-2189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "JASON",
        "middle_name": "HAYES",
        "name_prefix": "Mr.",
        "credential": "LCPC, CDAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "LPC-3639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807281800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan C Golob, CRNA
• Eleanor M Goltz, MSW
• Christian Raye Gonzales
• Pamela Denise Gonzales, LMP
• Jamie Goodwin
• Tara Goodwin
• Aimee M Goold, ARNP, FNP-BC
• John Edward Gordon, M.D.
• Kasie Dawn Gordon, MP
• Sarah Gore

• Professional Counselor in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Professional Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.