Kimberly Lynn Goodwin, BSN, MRC, CRC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401010236 Issued in MI

Practice address

25490 Little Mack Ave
Saint Clair Shores, MI 48081-2157

Phone

(586) 246-7837

NPI assigned

Feb 9, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing

State licenses

Practice roles

Locations

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

• Blue Water Counseling and Wellness Center, Inc.

  • Community/Behavioral Health Agency
  • Roseville, MI
  • NPI 1023560851
  NPD Authorized official

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

{
    "created_epoch": "1423440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477008000000",
    "number": "1245621507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25490 LITTLE MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812157",
            "telephone_number": "586-246-7837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25490 LITTLE MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812157",
            "telephone_number": "586-246-7837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "KIMBERLY",
        "middle_name": "LYNN",
        "credential": "BSN, MRC, CRC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-09",
        "last_updated": "2016-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401010236",
            "primary": true
        },
        {
            "code": "163WR0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Rehabilitation",
            "state": "MI",
            "license": "4704247001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11861990",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George Thomas Goffas, MD
• Richard N Goich, DPM
• Ian Goldsbrough, MS, LPC
• Christopher S Goldsby, MD
• Raylynn Marie Gonzales
• Mallory Margret Gordon, LLP
• Robert Allen Gordy, MOT
• Marc Oliver Gosselin, DO
• Kevin J Grady, M.D.
• Meagan Grammatico, MT-BC

• Professional Counselor in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.