Kelsi McBrayer Godwin, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8347-C Issued in AR

Practice address

1792 E Joyce Blvd Ste 105
Fayetteville, AR 72703-5253

Phone

(479) 358-7690

NPI assigned

Oct 21, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kelsi Lynn McBrayer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Activelife Counseling, LLC

  • Professional Counselor
  • Fayetteville, AR
  • NPI 1053918169

  Clinical

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1700485661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7452 CHARLOTTE AVE",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727627021",
            "telephone_number": "479-208-3402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1792 E JOYCE BLVD STE 105",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035253",
            "telephone_number": "479-358-7690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODWIN",
        "first_name": "KELSI",
        "middle_name": "MCBRAYER",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-21",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AR",
            "license": "8347-C",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "8347-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSI",
            "last_name": "MCBRAYER",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kara L Glenn
• Becky Gleue
• Michael Glidewell
• Josiah Glise, DO
• David Jeffrey Glover, LCSW
• Akila Aditi Goel, DO
• Lauren Goff
• Jessie Golden, MS RDN LD
• Brooke Goldhammer, MCD, CF-SLP
• David Gomez

• Clinical Social Worker in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.