MEDICARE: COURTNEY GOLDING PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301017187	MI

General Provider Information

NPI Number	:	1881138220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY GOLDING PHD

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC 845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:	616-486-6790
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 LAKE DR SE STE 200
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-8292
Country	:	US
Telephone Number	:	616-391-3759
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2016
Last Update Date	:	06/09/2026

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