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NPI Code Detail

MEDICARE: STEPHANIE GOODRUM LPC

MEDICARE: STEPHANIE GOODRUM LPC
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
1101YP2500XProfessional CounselorLPC1677TN
2104100000XSocial WorkerLPC 1677TN
3101YM0800XMental Health CounselorLPC1677TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14099873OTHERTNBCBS PROVIDER NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972611788
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE GOODRUM LPC
Provider Business Mailing Address
First Line : 3772 HIGHWAY 45 S
Second Line :
City : SELMER
State : TN
Zip : 38375-6606
Country : US
Telephone Number : 731-645-5753
Fax Number : 731-645-9885
Provider Business Practice Location Address
First Line : 641 E POPLAR AVE
Second Line :
City : SELMER
State : TN
Zip : 38375-1828
Country : US
Telephone Number : 731-645-5753
Fax Number : 731-645-9885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2006
Last Update Date : 02/19/2024

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Directions to “ STEPHANIE GOODRUM LPC” Practice Location

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