Provider Demographics
NPI:1497639066
Name:GODDESS AVE.
Entity type:Organization
Organization Name:GODDESS AVE.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:832-882-4960
Mailing Address - Street 1:10530 CABOT TRL
Mailing Address - Street 2:
Mailing Address - City:IOWA COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:77583-4285
Mailing Address - Country:US
Mailing Address - Phone:832-882-4960
Mailing Address - Fax:
Practice Address - Street 1:10530 CABOT TRL
Practice Address - Street 2:
Practice Address - City:IOWA COLONY
Practice Address - State:TX
Practice Address - Zip Code:77583-4285
Practice Address - Country:US
Practice Address - Phone:832-882-4960
Practice Address - Fax:832-882-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty