Provider Demographics
NPI:1710700703
Name:EMERTON-GODWIN, PAULA MAE (LCPC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MAE
Last Name:EMERTON-GODWIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 E SPEEDWAY BLVD APT 72
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-4005
Mailing Address - Country:US
Mailing Address - Phone:214-405-7087
Mailing Address - Fax:
Practice Address - Street 1:10210 E SPEEDWAY BLVD APT 72
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-4005
Practice Address - Country:US
Practice Address - Phone:214-405-7087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8795101YP2500X
AZ23870101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional