Provider Demographics
NPI:1538855937
Name:GODFREY, CURTIS REX (SUDP)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:REX
Last Name:GODFREY
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7637 PACIFIC AVE # E63
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-7063
Mailing Address - Country:US
Mailing Address - Phone:253-287-1310
Mailing Address - Fax:
Practice Address - Street 1:8717 S HOSMER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-1819
Practice Address - Country:US
Practice Address - Phone:253-473-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61375195101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty