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Provider Information for 1003036302



COURTNEY ELAINE GOODRUM LCSW

Gender: FEMALE

Individual NPI: 1003036302

Calendar Last Updated: 2018-04-20

Details

Name Value
NPI 1003036302
Enumeration Date 2007-04-27
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 1 W SUNBRIDGE DR
FAYETTEVILLE, AR 72703-1825
United States

Phone: 479-443-5575 | Fax: 479-750-8967
View Map External Link
Primary Practice Address 1 W SUNBRIDGE DR
FAYETTEVILLE, AR 72703-1825
United States

Phone: 479-443-5575 | Fax:
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1041C0700X - Social Worker Clinical AR 1611-C
Other Identifiers
Issuer State Number