Kevon Jabarr Goodrum

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFT001607 Issued in GA

Practice address

46 Ridge Rd
Hamden, CT 06517-3506

Phone

(203) 752-8827

NPI assigned

Jun 26, 2009

Last updated

Apr 27, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. K. Jabarr Goodrum Other name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Counseling Services of Atlanta, LLC

  • Professional Counselor
  • Marietta, GA
  • NPI 1508271024
  Medicare reassignment NPD

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

{
    "created_epoch": "1245974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714176000000",
    "number": "1831327006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 HIDDEN SPRINGS WALK SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300824254",
            "telephone_number": "678-444-4505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 RIDGE RD",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065173506",
            "telephone_number": "203-752-8827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODRUM",
        "first_name": "KEVON",
        "middle_name": "JABARR",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-26",
        "last_updated": "2024-04-27",
        "certification_date": "2024-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "MFT001607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "K.",
            "last_name": "GOODRUM",
            "middle_name": "JABARR",
            "prefix": "MR.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Cynthia Gonzalez, RPT
• Janaya Marie Gonzalez
• Good Space LLC
• Kelsey Goode, PA
• Lauren Goodman
• Sonia Gordon-Dole, M.D.
• Kathryn Elizabeth Gould, P.A.
• GP of Hamden, P.C.
• Kim Gramlich, OTR L
• Abiola J Grant

• Marriage & Family Therapist in Hamden, CT
• Providers in Hamden, CT by specialty
• Marriage & Family Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.