Healthcare Provider Details

I. General information

NPI: 1174055776
Provider Name (Legal Business Name): COURTNEY GODDARD BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY ELIZABETH SUMMERS

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 E BROADWAY ST
MOUNT PLEASANT MI
48858-2933
US

IV. Provider business mailing address

2260 E PLEASANT VALLEY RD
SHEPHERD MI
48883-9523
US

V. Phone/Fax

Practice location:
  • Phone: 989-560-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001973
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: