Individual
STEPHANIE GOODRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
641 E POPLAR AVE, SELMER, TN 38375-1828
(731) 645-5753
(731) 645-9885
Mailing address
3772 HIGHWAY 45 S, SELMER, TN 38375-6606
(731) 645-5753
(731) 645-9885
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC1677
TN
101YP2500X
Professional Counselor
LPC1677
TN
104100000X
Social Worker
LPC 1677
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4099873
BCBS PROVIDER NUMBER
TN
05
—
572994000
—
TN
Enumeration date
08/29/2006
Last updated
02/19/2024
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