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Provider Information for 1003036302



COURTNEY ELAINE GOODRUM LCSW

Gender: FEMALE

Individual NPI: 1003036302

Calendar Last Updated: 2014-02-11

Details

Name Value
NPI 1003036302
Enumeration Date 2007-04-27
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 2400 S. 48TH STREET
SPRINGDALE, AR 72762
United States

Phone: 479-750-2020 | Fax: 479-750-8967
View Map External Link
Primary Practice Address 2400 S. 48TH STREET
SPRINGDALE, AR 72762
United States

Phone: 479-750-2020 | Fax: 479-750-8967
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1041C0700X - Social Worker Clinical AR 1611-C
No 1041C0700X - Social Worker Clinical CA 1611-C
Other Identifiers
Issuer State Number