Individual
DR. JOHN PHILLIP GODFREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
5750 BALCONES DR STE 106, AUSTIN, TX 78731-4268
(737) 202-5789
(737) 209-7080
Mailing address
PO BOX 152680, AUSTIN, TX 78715-2680
(512) 292-1122
(512) 292-1144
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
25101
TX
103TA0700X
Adult Development & Aging Psychologist
25101
TX
103TB0200X
Cognitive & Behavioral Psychologist
25101
TX
103TC0700X
Clinical Psychologist
Primary
25101
TX
103TC2200X
Clinical Child & Adolescent Psychologist
25101
TX
103TF0000X
Family Psychologist
25101
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003LJ
BCBS NUMBER
TX
05
—
040973202
—
TX
01
—
160306
VALUE OPTIONS
TX
01
—
97034000
MAGELLAN ID NUMBER
TX
Enumeration date
08/11/2006
Last updated
04/27/2023
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