Healthcare Provider Details

I. General information

NPI: 1053659268
Provider Name (Legal Business Name): COURTNEY BILLINGTON GODBOUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY TAYLOR BILLINGTON

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W BIG BEAVER RD STE 780
TROY MI
48084-4745
US

IV. Provider business mailing address

888 W BIG BEAVER RD STE 780
TROY MI
48084-4745
US

V. Phone/Fax

Practice location:
  • Phone: 248-406-6756
  • Fax:
Mailing address:
  • Phone: 248-406-6756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801105467
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP012293
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number02192013
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114858
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: