Provider Demographics
NPI:1659728913
Name:GOODEN, KORI NOELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KORI
Middle Name:NOELLE
Last Name:GOODEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8676 GOODWOOD BLVD SUITE 105
Mailing Address - Street 2:ALTERNATE THERAPEUTIC SOLUTIONS, LLC
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7900
Mailing Address - Country:US
Mailing Address - Phone:225-636-5817
Mailing Address - Fax:866-507-9329
Practice Address - Street 1:1315 NASA PKWY APT 176
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3159
Practice Address - Country:US
Practice Address - Phone:225-620-7804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX677241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67724OtherLICENSED CLINICAL SOCIAL WORKER CREDENTIAL