| Courtney Goodrum Llc | |
|
1 W Sunbridge Dr Fayetteville AR 72703-1825 | |
| (479) 443-5575 | |
| (479) 443-9554 |
| Full Name | Courtney Goodrum Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1 W Sunbridge Dr, Fayetteville, Arkansas |
| Authorized Official Name and Position | Courtney Elaine Goodrum (OWNER) |
| Authorized Official Contact | 4793666479 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Courtney Goodrum Llc 1 W Sunbridge Dr Fayetteville AR 72703-1825 Ph: (479) 443-5575 | Courtney Goodrum Llc 1 W Sunbridge Dr Fayetteville AR 72703-1825 Ph: (479) 443-5575 |
| NPI Number | 1922845643 |
|---|---|
| Provider Enumeration Date | 07/10/2024 |
| Last Update Date | 07/10/2024 |
| Certification Date | 07/10/2024 |
| Medicare PECOS PAC ID | 5193257913 |
|---|---|
| Medicare Enrollment ID | O20241018000174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922845643 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Courtney E Goodrum |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003036302 PECOS PAC ID: 3274603121 Enrollment ID: I20080603000838 |
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