Provider Demographics
NPI:1093556326
Name:GOODWIN, COURTNEY (MA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7842 N VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2292
Mailing Address - Country:US
Mailing Address - Phone:805-220-0797
Mailing Address - Fax:
Practice Address - Street 1:5080 N FRUIT AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3062
Practice Address - Country:US
Practice Address - Phone:559-493-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103T00000XBehavioral Health & Social Service ProvidersPsychologist